94 results on '"Smadar Kort"'
Search Results
2. Racial and Ethnic Disparities in Aortic Stenosis
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Puja B. Parikh and Smadar Kort
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Editorials ,aortic stenosis ,aortic valve ,aortic valve replacement ,ethnic ,race ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2022
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3. Atrial Septal Defect Closure Device–Related Infective Endocarditis in a 20-Week Pregnant Woman
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Navneet Sharma, MD, Ul Weena, MD, John Medamana, MD, Noelle Mann, MD, Paul Strachan, MD, Joanna Chikwe, MD, and Smadar Kort, MD
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atrial septal defect ,echocardiography ,endocarditis ,pregnancy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
With increasing atrial septal defect (ASD) repairs, more women of childbearing age will have ASD closure devices. Current ASD closure trials have excluded women planning pregnancy, making their management challenging. We present a pregnant woman, with a repaired ASD, who presented with device-related infective endocarditis. (Level of Difficulty: Beginner.)
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- 2021
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4. ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak
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Contributors: James Kirkpatrick, Carol Mitchell, Cynthia Taub, Smadar Kort, Judy Hung, and Madhav Swaminathan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2020
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5. Anabolic steroids, acute myocardial infarction and polycythemia: A case report and review of the literature
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Kathleen Stergiopoulos, Joseph J Brennan, Robin Mathews, John F Setaro, and Smadar Kort
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acute myocardial infarction ,anabolic steroid use ,polycythemia. ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Kathleen Stergiopoulos1, Joseph J Brennan2, Robin Mathews1, John F Setaro2, Smadar Kort11Division of Cardiovascular Medicine, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA; 2Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT, USAAbstract: The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent “stacked” use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse.Keywords: acute myocardial infarction, anabolic steroid use, polycythemia
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- 2008
6. Initial experience using contrast enhanced real-time three-dimensional exercise stress echocardiography in a low-risk population
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Smadar Kort, Juan Gamboa, Barbara Blizzard, Laura Buzzanca, Samira Bahrainy, and Kathleen Stergiopoulos
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Stress echocardiography, Three dimensional stress echocardiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although emerging data support the utility of real-time three-dimensional echocardiography (RT3DE) during dobutamine stress testing, the feasibility of performing contrast enhanced RT3DE during exercise treadmill stress has not been explored. Two-dimensional (2D) and three-dimensional (3D) acquisition were performed in 39 patients at rest and peak exercise. Contrast was used in 29 patients (74%). Reconstruction was performed manually by generating short axis cut planes at the base, mid-ventricle and apex, and automatically by generating 9 short axis slices. Three-dimensional acquisition was feasible during rest and stress regardless of the use of contrast. Time to acquire stress images was reduced using 3D (35.2±17.9 s) as compared to 2D acquisition (51.6±14.7 s; P less then 0.05). Using a 17-segment model, of all 663 segments, 588 resting (88.6%) and 563 stress segments (84.9%) were adequately visualized using manually reconstructed 3D data, compared with 618 resting (93.2%) and 606 stress segments (91.4%) using 2D data (P rest=0.06; P stress=0.07). We concluded that contrast enhanced RT3DE is feasible during treadmill stress echocardiography.
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- 2010
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7. Predictors of 1-Year Mortality in Men Versus Women Undergoing Transfemoral Transcatheter Aortic Valve Implantation
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Samantha Novotny, Smadar Kort, Henry Tannous, Robert Pyo, Ely Gracia, Ting-Yu Wang, Susan Callahan, Hal Skopicki, Thomas Bilfinger, and Puja B. Parikh
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Male ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Humans ,Female ,Aortic Valve Stenosis ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Severity of Illness Index - Abstract
Although gender-related disparities in intermediate-term outcomes have been reported after transcatheter aortic valve implantation (TAVI), disparate predictors of mortality in men and women who underwent TAVI have not been well studied. This prospective institutional registry study included 297 consecutive patients (153 men, 144 women) who underwent transfemoral TAVI from December 2015 to June 2018 at an academic tertiary medical center. Baseline and clinical characteristics, procedural data, and clinical outcomes at 1 year were recorded. Mortality rates at 1 year were 11.1% and 20.3% in women and men, respectively (p = 0.033). Risk-adjusted mortality was significantly higher in men who underwent TAVI than in women (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.24 to 4.87, p = 0.010). Gender-specific risk-adjusted predictors of 1-year mortality post-TAVI included the presence of atrial fibrillation (OR 4.20, 95% CI 1.31 to 13.46, p = 0.016) and peripheral artery disease (OR 4.64, 95% CI 1.04 to 20.71, p = 0.044) in women and presence of chronic obstructive pulmonary disease (OR 3.14, 95% CI 1.13 to 8.72, p = 0.029), higher serum creatinine (OR 1.57, 95% CI 1.15 to 2.15, p = 0.004), and lower body mass index (OR 0.88, 95% CI 0.80 to 0.97, p = 0.008) in men. In this prospective institutional registry of adults who underwent TAVI, risk-adjusted 1-year mortality is significantly lower in women, and disparate predictors of risk-adjusted 1-year mortality exist in men and women.
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- 2023
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8. The Use of Quality Improvement Interventions in Reducing Rarely Appropriate Echocardiograms: A Systematic Review and Meta-Analysis
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Michael Tao, Mohammed Al-Sadawi, Navid Ahmed, Neda Dianati-Maleki, Noelle Mann, and Smadar Kort
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Background: As the volume of cardiac imaging continues to increase, so is the number of tests performed for rarely appropriate indications. Appropriate use criteria (AUC) documents were published by professional societies with quality improvement (QI) interventions developed in various institutions. However, the effectiveness of these interventions has not been assessed in a systematic fashion. Methods: We performed a database search for studies reporting the association between cardiac imaging, AUC and QI. We selected studies assessing the effect of QI interventions on performance of rarely appropriate echocardiograms. The primary endpoint was reduction of rarely appropriate testing. Results: Nine studies with 22,070 patients met inclusion criteria. QI interventions resulted in statistically significant reduction in rarely appropriate tests (OR 0.52, 95% CI 0.41-0.66; p 3 months) post intervention (OR 0.62, 95% CI: 0.49-0.79; p0.05). Conclusion: QI interventions are associated with a significant reduction in performance of rarely appropriate echocardiography testing, the effects of which persist over time.
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- 2023
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9. Atrial Septal Defect Closure Device–Related Infective Endocarditis in a 20-Week Pregnant Woman
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Smadar Kort, Joanna Chikwe, Noelle Mann, Paul Strachan, Ul Weena, Navneet Sharma, and John Medamana
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0301 basic medicine ,medicine.medical_specialty ,CHD - Congenital heart disease ,genetic structures ,PFO, patent foramen ovale ,TTE, transthoracic echocardiogram ,Case Report ,030105 genetics & heredity ,behavioral disciplines and activities ,03 medical and health sciences ,ASD - Atrial septal defect ,0302 clinical medicine ,Clinical Case ,mental disorders ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Endocarditis ,echocardiography ,atrial septal defect ,Pregnancy ,TEE, transesophageal echocardiogram ,business.industry ,ASD, atrial septal defect ,medicine.disease ,Surgery ,CHD, congenital heart disease ,PFO - Patent foramen ovale ,IE, infective endocarditis ,RC666-701 ,Infective endocarditis ,Childbearing age ,Atrial Septal Defect Closure Device ,endocarditis ,pregnancy ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
With increasing atrial septal defect (ASD) repairs, more women of childbearing age will have ASD closure devices. Current ASD closure trials have excluded women planning pregnancy, making their management challenging. We present a pregnant woman, with a repaired ASD, who presented with device-related infective endocarditis. (Level of Difficulty: Beginner.), Graphical abstract
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- 2021
10. Specific Considerations for the Protection of Patients and Echocardiography Service Providers When Performing Perioperative or Periprocedural Transesophageal Echocardiography during the 2019 Novel Coronavirus Outbreak: Council on Perioperative Echocardiography Supplement to the Statement of the American Society of Echocardiography Endorsed by the Society of Cardiovascular Anesthesiologists
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Yasdet Maldonado, Smadar Kort, G. Burkhard Mackensen, Madhav Swaminathan, and Alina Nicoara
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Heart Defects, Congenital ,Consensus ,Best practice ,Pneumonia, Viral ,030204 cardiovascular system & hematology ,Perioperative Care ,Disease Outbreaks ,030218 nuclear medicine & medical imaging ,Betacoronavirus ,03 medical and health sciences ,Patient safety ,Fetal Heart ,0302 clinical medicine ,Anesthesiology ,Pregnancy ,Medical advice ,Disease Transmission, Infectious ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Child ,Pandemics ,Societies, Medical ,Notice ,SARS-CoV-2 ,business.industry ,Disclaimer ,Warranty ,COVID-19 ,Service provider ,medicine.disease ,United States ,Disciplinary action ,Radiology Nuclear Medicine and imaging ,Female ,Patient Safety ,Medical emergency ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Notice and Disclaimer This statement reflects recommendations based on expert opinion, national guidelines, and available evidence. Our knowledge with regard to COVID-19 continues to evolve, as do our institutional protocols for dealing with invasive and non-invasive procedures and practice of personal protective equipment. Readers are urged to follow national guidelines and their institutional recommendations regarding best practices to protect their patients and themselves. These reports are made available by ASE as a courtesy reference source for its members. The reports contain recommendations only and should not be used as the sole basis to make medical practice decisions or for disciplinary action against any employee. The statements and recommendations contained in these reports are primarily based on the opinions of experts, rather than on scientifically-verified data. ASE makes no express or implied warranties regarding the completeness or accuracy of the information in these reports, including the warranty of merchantability or fitness for a particular purpose. In no event shall ASE be liable to you, your patients, or any other third parties for any decision made or action taken by you or such other parties in reliance on this information. Nor does your use of this information constitute the offering of medical advice by ASE or create any physician-patient relationship between ASE and your patients or anyone else.
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- 2020
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11. SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection
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Charles E. Chambers, James A. Goldstein, Smadar Kort, Roxana Mehran, Lloyd W. Klein, David A. Cox, C. Michael Valentine, and David Haines
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Position statement ,business.industry ,MEDLINE ,030204 cardiovascular system & hematology ,equipment and supplies ,medicine.disease ,Occupational safety and health ,Radiation exposure ,03 medical and health sciences ,Health personnel ,0302 clinical medicine ,Health care ,Radiation monitoring ,Medicine ,030212 general & internal medicine ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Abstract
Renewed attention has focused on the occupational health hazards posed by working in the fluoroscopic laboratory ([1–6][1]). Accumulated occupational radiation exposure is associated with health risks to physicians, nurses, and technologists working in this environment. Health care workers are
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- 2020
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12. SCAI multi‐society position statement on occupational health hazards of the catheterization laboratory: Shifting the paradigm for Healthcare Workers' Protection
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C. Michael Valentine, Lloyd W. Klein, James A. Goldstein, David A. Cox, Charles E. Chambers, David Haines, Smadar Kort, and Roxana Mehran
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Position statement ,Cardiac Catheterization ,Consensus ,MEDLINE ,030204 cardiovascular system & hematology ,Radiography, Interventional ,Risk Assessment ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Occupational Exposure ,Health care ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Musculoskeletal Diseases ,030212 general & internal medicine ,Radiation Injuries ,Occupational Health ,business.industry ,Extramural ,General Medicine ,Protective Factors ,Radiation Exposure ,equipment and supplies ,medicine.disease ,Radiation exposure ,Medical emergency ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business - Abstract
Renewed attention has focused on the occupational health hazards posed by working in the fluoroscopic laboratory ([1–6][1]). Accumulated occupational radiation exposure is associated with health risks to physicians, nurses, and technologists working in this environment. Health care workers are
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- 2020
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13. BIOMARKERS AND STRAIN ECHOCARDIOGRAPHY FOR THE DETECTION OF SUBCLINICAL CARDIOTOXICITY IN BREAST CANCER PATIENTS RECEIVING ANTHRACYCLINES
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Aditi A. Bhagat, Andreas P. Kalogeropoulos, Smadar Kort, Hal A. Skopicki, Javed Butler, and Michelle Weisfelner Bloom
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Cardiology and Cardiovascular Medicine - Published
- 2023
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14. Prevalence and Predictors of Cardiovascular Disease and Risk Factors in Transgender Persons in the United States
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Hal A. Skopicki, Noelle Mann, Smadar Kort, Tara Lauther, Puja B. Parikh, and Aditi Malhotra
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Male ,education.field_of_study ,business.industry ,Population ,Psychological intervention ,MEDLINE ,Disease ,medicine.disease ,Transgender Persons ,United States ,Cross-Sectional Studies ,Cardiovascular Diseases ,Risk Factors ,Diabetes mellitus ,Transgender ,Cohort ,Prevalence ,Medicine ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,business ,education ,Kidney disease ,Demography - Abstract
Background The cardiovascular health of transgender and gender diverse (TGD) persons, a growing population in the U.S., has become a subject of heightened interest. We sought to assess the prevalence and predictors of cardiovascular disease (CVD) in transgender men, transgender women, and gender non-conforming persons in the U.S. Methods A cohort of individuals self-identified as TGD (i.e. transgender or gender non-conforming) in the U.S. was identified using the 2018 Centers for Disease Control's Behavioral Risk Factor Surveillance Survey (BRFSS). Results Among the 1,019 TGD individuals studied, 378 (37.1%) identified their transition status as male-to-female, 394 (38.7%) as female-to-male, and the remaining 247 (24.2%) as gender non-conforming. A total of 138 (13.5%) had reported CVD while 881 (86.5%) did not. The prevalence of CVD in TGD individuals identified as male-to-female, female-to-male, and gender non-conforming were noted to be similar (14.6% vs 13.5% vs 12.1%, p=0.69). TGD persons with CVD were older with lower annual income. They also had higher rates of smoking, lower rates of regular exercise, and higher rates of smoking and chronic medical comorbidities. Independent predictors of CVD in TGD persons included older age, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and depressive disorder. Conclusions In this contemporary cross-sectional nationally representative survey, CVD was prevalent in nearly 14% of TGD persons. Further studies examining interventions to reduce CV risk and enhance access to medical care in the TGD population are warranted.
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- 2021
15. Heal Thyself to Heal and Cure: Voices of Women in Cardiology
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Christina Cardy, Sherry-Ann Brown, Jane A. Linderbaum, Ami B. Bhatt, Gina Lundberg, Kamala P Tamirisa, Laxmi S. Mehta, Marci Farquhar-Snow, Smadar Kort, and Hena Patel
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burnout ,COVID-19, coronavirus disease-2019 ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Voices in Cardiology ,COVID-19 ,Burnout ,Viewpoint ,Nursing ,well-being ,self-care ,WHO, World-Health Organization ,PPE-Personal protective equipment ,Self care ,Medicine ,ACC, American College of Cardiology ,Cardiology and Cardiovascular Medicine ,business ,PPE, personal protective equipment - Published
- 2021
16. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease
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John U, Doherty, Smadar, Kort, Roxana, Mehran, Paul, Schoenhagen, Prem, Soman, and Michael J, Wolk
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medicine.medical_specialty ,Heart Diseases ,Heart disease ,Psychological intervention ,Context (language use) ,Physician Decision ,030204 cardiovascular system & hematology ,Multimodal Imaging ,Appropriate Use Criteria ,030218 nuclear medicine & medical imaging ,Multimodality ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Modality (human–computer interaction) ,business.industry ,Patient Selection ,valvular heart disease ,medicine.disease ,United States ,Cardiac Imaging Techniques ,Cardiology and Cardiovascular Medicine ,business - Abstract
This document is the second of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. The first document (J Am Coll Cardiol 2017;70:1647-1672) addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas this document addresses this topic with regard to structural (nonvalvular) heart disease. While dealing with different subjects, the 2 documents do share a common structure and feature some clinical overlap. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of structural and valvular heart disease, encompassing multiple imaging modalities. Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association Clinical Practice Guidelines. A separate, independent rating panel scored the 102 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario. The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations in which diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.
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- 2019
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17. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease
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John U. Doherty, Smadar Kort, Roxana Mehran, Paul Schoenhagen, Prem Soman, Gregory J. Dehmer, Thomas M. Bashore, Nicole M. Bhave, Dennis A. Calnon, Blase Carabello, John Conte, Timm Dickfeld, Daniel Edmundowicz, Victor A. Ferrari, Michael E. Hall, Brian Ghoshhajra, Praveen Mehrotra, Tasneem Z. Naqvi, T. Brett Reece, Randall C. Starling, Molly Szerlip, Wendy S. Tzou, John B. Wong, Steven R. Bailey, Alan S. Brown, Stacie L. Daugherty, Larry S. Dean, Milind Y. Desai, Claire S. Duvernoy, Linda D. Gillam, Robert C. Hendel, Christopher M. Kramer, Bruce D. Lindsay, Warren J. Manning, Manesh R. Patel, Ritu Sachdeva, L. Samuel Wann, David E. Winchester, and Michael J. Wolk
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart disease ,business.industry ,medicine.disease ,Appropriate Use Criteria ,Multimodality ,Internal medicine ,medicine ,Cardiology ,Surgery ,Radiology, Nuclear Medicine and imaging ,Cardiac structure ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
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18. Gender Disparities in Management and Outcomes Following Transcatheter Aortic Valve Implantation With Newer Generation Transcatheter Valves
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Ting-Yu Wang, Daniel Montellese, Shamim Khan, Susan Callahan, Robert Pyo, Thomas V. Bilfinger, Smadar Kort, Henry Tannous, Neal Patel, Joanna Chikwe, Hal Skopicki, Giridhar Korlipara, Jonathan Weinstein, Ely Gracia, and Puja B. Parikh
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Sex Distribution ,Prospective cohort study ,Stroke ,Aged ,Aged, 80 and over ,Ejection fraction ,business.industry ,Incidence ,Warfarin ,Disease Management ,Atrial fibrillation ,Aortic Valve Stenosis ,Prognosis ,medicine.disease ,Clopidogrel ,United States ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Female ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
The impact of gender on management and early outcomes after transcatheter aortic valve implantation (TAVI) in the setting of newer generation transcatheter heart valves (THVs) is not well known. We evaluated gender-specific differences on clinical management and in-hospital outcomes in adults who underwent TAVI with newer generation THVs. The study population included 298 consecutive patients who underwent TAVI and received a newer generation THV (Sapien 3 [Edwards Lifesciences, Irvine, California] or Corevalve Evolut R or Evolut Pro [Medtronic, Minneapolis, Minnesota]) from December 2015 to June 2018 at an academic tertiary medical center. Of the 298 patients, 154 (52%) were men and 144 (48%) were women. Compared with men, women were older, had lower serum creatinine, higher left ventricular ejection fraction, and lower rates of multiple co-morbidities, including previous coronary artery bypass graft surgery, previous myocardial infarction, and atrial fibrillation. Women were noted to have smaller aortic annular area and perimeter and underwent implantation of smaller THVs than men. At the time of discharge, women were more frequently prescribed a P2Y12 inhibitor (primarily clopidogrel) and less frequently prescribed oral anticoagulation (namely warfarin). Hospital length of stay and in-hospital rates of mortality, disabling stroke, and pacemaker were similar in men and women. In conclusion, in this observational prospective study of adults who underwent TAVI with newer generation THVs, while gender-related disparities in clinical presentation and procedural management were observed, no significant difference in clinical outcomes were noted in men and women. Further studies examining gender-related differences in procedural and postprocedural care after TAVI in the contemporary era are warranted to better understand and optimize clinical outcomes in both men and women.
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- 2019
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19. ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak: Endorsed by the American College of Cardiology
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Smadar Kort, Carol Mitchell, Cynthia C. Taub, Judy Hung, James N. Kirkpatrick, and Madhav Swaminathan
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Echo (communications protocol) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,education ,030204 cardiovascular system & hematology ,Service provider ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Radiology Nuclear Medicine and imaging ,Pandemic ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical emergency ,business ,Cardiology and Cardiovascular Medicine - Abstract
• ASE guidance for patient and provider protection during echo exams in the COVID-19 pandemic. • Triaging approach for prioritizing echo exams during the COVID-19 pandemic. • Recommended imaging approach and appropriate PPE use during echo exams.
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- 2020
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20. Abstract 237: Prevalence of Cardiovascular Risk Factors and Cardiovascular Disease in Transgender Persons in The United States
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Noelle Mann, Hal Skopicki, Smadar Kort, Puja B. Parikh, and Aditi Malhotra
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Gerontology ,business.industry ,Cardiovascular risk factors ,Transgender ,Medicine ,Disease ,Transgender Person ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: There is a paucity of data regarding prevalence of cardiovascular disease (CVD) and corresponding cardiovascular (CV) risk factors in transgender individuals. We sought to assess the prevalence of CV risk factors and CVD in transgender persons in the United States. Methods: The 2018 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 1,038 transgender individuals in the United States. Presence of CVD was noted with a single affirmative response to the following questions: “Has a health care professional ever told you that you had any of the following:” (1) a heart attack or myocardial infarction, (2) angina or coronary heart disease, (3) a stroke? Results: Among the 1,038 transgender individuals studied, a total of 145 (14.0%) had CVD while 893 (86.0%) did not. No differences in prevalence of CVD was noted in transgender individuals who transitioned from male-to-female (n=387), female-to-male (n=400), and gender nonconforming status (n=251) (15.0% vs 13.8% vs 12.7%, p=0.72). Transgender individuals with CVD were older, had lower annual income, higher rates of smoking (28.4% vs 18.1%, p=0.004), and higher rates of multiple co-morbidities including asthma (26.6% vs 17.4%, p = 0.009), skin cancer (21.8% vs 5.0%, p Conclusions: In this observational contemporary study, CVD was prevalent in 14% of transgender individuals in the United States. Predictors of CVD in the transgender population exist and transgender persons should be appropriately screened for CV risk factors so as to minimize their risk of CVD.
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- 2020
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21. Sex-Related Differences in Early- and Long-Term Mortality After Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis
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Puja B, Parikh, Ting-Yu, Wang, Navneet, Sharma, Smadar, Kort, Hal A, Skopicki, Luis, Gruberg, Allen, Jeremias, Robert, Pyo, Joanna, Chikwe, and Javed, Butler
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Male ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Humans ,Female ,Aortic Valve Stenosis - Abstract
Observational data suggest that early- and long-term outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) differ significantly between men and women, but have demonstrated conflicting results. This study sought to examine early- and long-term mortality with TAVR and SAVR in women versus men.Electronic search was performed until February 2018 for studies reporting sex-specific mortality following TAVR or isolated SAVR. Data were pooled using random-effects models. Outcomes included rates of early mortality (in hospital or 30 days) and long term (1 year or longer).With 35 studies, a total of 80,928 patients were included in our systematic review and meta-analysis, including 40,861 men and 40,067 women. Pooled analyses suggested considerable sex-related differences in longterm mortality following TAVR and SAVR. Following SAVR, women had higher long-term mortality (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.16-1.56; P.001) and a trend toward higher early mortality (OR, 1.69; 95% CI, 0.97-2.97; P=.07) compared to men. Following TAVR, women had lower long-term mortality (OR, 0.78; 95% CI, 0.71-0.86; P.001) and no difference in early mortality (OR, 1.09; 95% CI, 0.96-1.23; P=.17) compared to men.In this systematic review and meta-analysis, women had higher long-term mortality and a trend toward higher early mortality compared to men following SAVR. Following TAVR, women had lower long-term mortality and no difference in early mortality compared with men.
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- 2020
22. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease
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John U. Doherty, Smadar Kort, Prem Soman, Roxana Mehran, and Paul Schoenhagen
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medicine.medical_specialty ,Modality (human–computer interaction) ,Heart disease ,business.industry ,valvular heart disease ,Psychological intervention ,Physician Decision ,Context (language use) ,030204 cardiovascular system & hematology ,medicine.disease ,Appropriate Use Criteria ,Multimodality ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,030212 general & internal medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
This document is 1 of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. This document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas the second, companion document addresses this topic with regard to structural heart disease. Although there is clinical overlap, the documents addressing valvular and structural heart disease are published separately, albeit with a common structure. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of valvular and structural heart disease, encompassing multiple imaging modalities. Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association guidelines. A separate, independent rating panel scored the 92 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario. The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations where diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.
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- 2017
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23. Echocardiographic evaluation of patients presenting with acutely decompensated heart failure in the setting of dietary or medication noncompliance-Is there a role?
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Smadar Kort and Michael Goyfman
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Male ,Cardiac function curve ,medicine.medical_specialty ,Exacerbation ,030204 cardiovascular system & hematology ,Appropriate Use Criteria ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Heart Failure ,Ejection fraction ,business.industry ,medicine.disease ,Blood pressure ,Echocardiography ,Heart failure ,Pulmonary artery ,cardiovascular system ,Etiology ,Cardiology ,Patient Compliance ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Reevaluating patients who are admitted with heart failure (HF) exacerbation using echocardiogram is a common and appropriate indication. However, it is unknown whether it is appropriate to reevaluate such patients when the exacerbation is attributed to patients' noncompliance with self-care behaviors, where the presumption is that the underlying HF biology is stable. Methods Echocardiograms on all patients hospitalized for HF exacerbation attributed to dietary or medication noncompliance were retrospectively assessed for the presence of significant changes from prior echocardiogram. Results A total of 559 charts of patients admitted with heart failure exacerbation were reviewed, of which 125 patients (22%) were thought to have dietary or medication noncompliance as the etiology. Fifty-three patients (42%) had a follow-up echocardiogram performed during the index admission. The likelihood of being reevaluated by an echocardiogram during admission was not affected by the clinical service that the patient was admitted to, the patient's gender, or age. Eighty percent of echocardiograms performed within a year of prior study and 78% of echocardiograms performed >1 year revealed at least one significant change. The most common changes identified were an increase in left atrium diameter, worsening of pulmonary artery systolic pressure and worsening ejection fraction. There was no correlation between the time interval of between echocardiograms and the likelihood of a significant change. Conclusions Repeat echocardiograms in patients admitted with HF exacerbation due to noncompliance revealed significant changes in the majority of patients studied. The changes may reflect worsening in cardiac function in addition to the presumed etiology of noncompliance.
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- 2017
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24. Relation of Body Mass Index and Gender to Left Atrial Size and Atrial Fibrillation
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Aditi Malhotra, Smadar Kort, Luis Gruberg, Puja B. Parikh, and Gary Huang
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Male ,medicine.medical_specialty ,Population ,New York ,030204 cardiovascular system & hematology ,Overweight ,Risk Assessment ,Body Mass Index ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Odds Ratio ,medicine ,Humans ,Heart Atria ,Obesity ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,education ,Aged ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Age Factors ,Atrial fibrillation ,Organ Size ,Odds ratio ,Middle Aged ,medicine.disease ,Echocardiography ,Cardiology ,Female ,medicine.symptom ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Increased body mass index (BMI) and obesity are associated with greater risk of atrial fibrillation (AF). However, whether this correlation is independent and gender specific remains unclear. The objective of this study was to characterize the relation between BMI, left atrial (LA) size, and presence of AF and determine whether this association is gender specific. We prospectively studied 499 patients who underwent a transthoracic echocardiogram at an academic tertiary care medical center. Clinical and echocardiographic data were obtained. The primary outcome of interest was the presence of AF. Of 499 patients studied, 240 (48.1%) were men and 259 (51.9%) were women. Of these, 151 (30.1%) had normal BMI, 181 (36.3%) were overweight, and 167 (33.5%) were obese. Obese patients were younger and had larger LA diameters, LA areas (LAAs), and LA volumes (LAVs). Rates of AF were similar among the BMI classes in the overall population and in men and women separately. In multivariate analysis, BMI and gender were both independently associated with LA diameter, LAA, and LAV. Age (odds ratio 1.02, 95% CI 1.00 to 1.04, p = 0.023) and LA diameter (odds ratio 2.52, 95% CI 1.61 to 3.97, p
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- 2017
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25. CRT-600.34 Are There Gender Disparities in Presentation and Left Atrial Anatomy in Adults With Atrial Fibrillation Undergoing Watchman Left Atrial Appendage Occlusion?
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Neda Dianati Maleki, Hal Skopicki, Aditi Malhotra, Eric J. Rashba, Smadar Kort, and Puja B. Parikh
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Left atrial ,business.industry ,medicine.medical_treatment ,Occlusion ,medicine ,Atrial fibrillation ,Anatomy ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Left atrial appendage occlusion - Abstract
Left atrial appendage (LAA) occlusion has become the mainstay for treatment in adults with atrial fibrillation (AF) and a high bleeding risk. While accurate device sizing is critical for successful LAA occlusion and optimal clinical outcomes, it is unknown whether gender impacts LAA anatomy and
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- 2020
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26. CRT-600.24 Association of Diagnosis Related Group With 30-Day Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
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Thomas V. Bilfinger, Robert Pyo, Ely Gracia, Henry Tannous, Smadar Kort, Hal Skopicki, Susan Callahan, Puja B. Parikh, and Ting-Yu Wang
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medicine.medical_specialty ,nervous system ,Valve replacement ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,medicine ,In patient ,Diagnosis-related group ,macromolecular substances ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Abstract
The association between Medicare Severity-Diagnosis Related Group (DRG) and 30-day outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) has not been well studied. We aimed to evaluate the relationship between DRG and 30-day clinical outcomes in patients with severe
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- 2020
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27. Impact of Severity of Chronic Kidney Disease on Management and Outcomes Following Transcatheter Aortic Valve Replacement With Newer-Generation Transcatheter Valves
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Ely, Gracia, Ting-Yu, Wang, Susan, Callahan, Thomas, Bilfinger, Henry, Tannous, Robert, Pyo, Smadar, Kort, Hal, Skopicki, Jonathan, Weinstein, Neal, Patel, Daniel, Montellese, Giridhar, Korlipara, Shamim, Khan, Joanna, Chikwe, and Puja B, Parikh
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Male ,Aortic Valve Stenosis ,Equipment Design ,Kidney Function Tests ,Patient Readmission ,Risk Assessment ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,Outcome and Process Assessment, Health Care ,Postoperative Complications ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Female ,Renal Insufficiency, Chronic ,Aged - Abstract
The association between chronic kidney disease (CKD) and outcomes following transcatheter aortic valve replacement (TAVR) in the setting of newer-generation transcatheter heart valves (THVs) is not well known. Accordingly, we sought to assess the impact of CKD severity on outcomes in adults undergoing TAVR with newer-generation THVs.The study population included 298 consecutive patients who underwent TAVR with a newer-generation THV (Sapien 3 [Edwards Lifesciences] or CoreValve Evolut R or Evolut Pro [Medtronic]) from December 2015 to June 2018 at an academic tertiary medical center. Patients were classified into three groups: group I, defined as creatinine clearance (CrCl) ≥60 mL/ min (n = 133); group II, defined as CrCl ≥30 mL/min and60 mL/min (n = 128); and group III, defined as CrCl30 mL/min (n = 37).Median length of stay was longer in groups II and III (2.0 days in group I vs 3.0 days in group II vs 4.0 days in group III; P.01). While rates of 30-day readmission were significantly higher in groups II and III compared with group I (14.5% in group I vs 26.6% in group II vs 37.1% in group III; P.01), rates of in-hospital and 30-day mortality and disabling stroke were similar. In multivariable analysis, CKD was independently associated with higher 30-day readmission rates (group II: odds ratio, 2.10; 95% confidence interval 1.02-4.32; group III: odds ratio, 3.52; 95% confidence interval, 1.40-8.87; group I: referent).In this prospective study of adults undergoing TAVR with newer-generation THVs, moderate and severe CKD was associated with a nearly 2-fold and 3-fold higher risk of 30-day readmission, respectively.
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- 2019
28. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 appropriate use criteria for multimodality imaging in the assessment of cardiac structure and function in nonvalvular heart disease: A report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons
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John U, Doherty, Smadar, Kort, Roxana, Mehran, Paul, Schoenhagen, Prem, Soman, Gregory J, Dehmer, Thomas M, Bashore, Nicole M, Bhave, Dennis A, Calnon, Blase, Carabello, John, Conte, Timm, Dickfeld, Daniel, Edmundowicz, Victor A, Ferrari, Michael E, Hall, Brian, Ghoshhajra, Praveen, Mehrotra, Tasneem Z, Naqvi, T Brett, Reece, Randall C, Starling, Molly, Szerlip, Wendy S, Tzou, John B, Wong, Steven R, Bailey, Alan S, Brown, Stacie L, Daugherty, Larry S, Dean, Milind Y, Desai, Claire S, Duvernoy, Linda D, Gillam, Robert C, Hendel, Christopher M, Kramer, Bruce D, Lindsay, Warren J, Manning, Manesh R, Patel, Ritu, Sachdeva, L Samuel, Wann, David E, Winchester, and Michael J, Wolk
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Consensus ,Heart Diseases ,Predictive Value of Tests ,Advisory Committees ,Cardiology ,Humans ,Reproducibility of Results ,Prognosis ,Multimodal Imaging ,Societies, Medical ,United States - Abstract
This document is the second of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. The first document
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- 2019
29. Recommendations for Echocardiography Laboratories Participating in Cardiac Point of Care Cardiac Ultrasound (POCUS) and Critical Care Echocardiography Training: Report from the American Society of Echocardiography
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Amer M. Johri, James N. Kirkpatrick, Kelly Thorson, Samreen Raza, Arthur J. Labovitz, Bruce J. Kimura, Richard A. Grimm, Smadar Kort, Michael J. Lanspa, Joel Turner, and Sue Phillip
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medicine.medical_specialty ,business.industry ,Emergency medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Cardiac Ultrasound ,Point of care - Published
- 2020
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30. PREDICTORS OF CALCIFIC AORTIC VALVE STENOSIS PROGRESSION AS MEASURED BY CHANGE IN MEAN PRESSURE GRADIENT: A META-ANALYSIS AND META-REGRESSION
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Smadar Kort, Prateek Sharma, Clive Goulbourne, Dmitriy N. Feldman, Ramsey Kalil, Puja B. Parikh, Navneet Sharma, Paul Kim, and Sareena George
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medicine.medical_specialty ,business.industry ,Meta-analysis ,Internal medicine ,Cardiology ,medicine ,Mean pressure ,Meta-regression ,Calcific aortic valve stenosis ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
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31. PREDICTORS OF CALCIFIC AORTIC VALVE STENOSIS PROGRESSION AS MEASURED BY CHANGE IN PEAK VELOCITY: A META-ANALYSIS AND META-REGRESSION
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Dmitriy N. Feldman, Ramsey Kalil, Paul Kim, Prateek Sharma, Sareena George, Smadar Kort, Clive Goulbourne, Puja B. Parikh, and Navneet Sharma
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medicine.medical_specialty ,Peak velocity ,business.industry ,Meta-analysis ,Internal medicine ,Cardiology ,medicine ,Meta-regression ,Calcific aortic valve stenosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Identifying patients at risk of progression of Calcific Aortic Valve Stenosis (pCAVS) is important for optimal timing of diagnosis and treatment. Systematic review was conducted in accordance with the PRISMA guidelines. Search was preformed using databases for studies including patients with pCAVS
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- 2020
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32. ASE statement on protection of patients and echocardiography service providers during the 2019 novel coronavirus outbreak
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Madhav Swaminathan, Judy Hung, Cynthia C. Taub, Smadar Kort, James N. Kirkpatrick, and Carol Mitchell
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2019-20 coronavirus outbreak ,animal structures ,Organizational innovation ,Coronavirus disease 2019 (COVID-19) ,Statement (logic) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,education ,Outbreak ,030204 cardiovascular system & hematology ,Service provider ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,RC666-701 ,Pandemic ,Infection control ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,030212 general & internal medicine ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Abstract
Highlights • ASE guidance for patient and provider protection during echo exams in the COVID-19 pandemic. • Triaging approach for prioritizing echo exams during the COVID-19 pandemic. • Recommended...
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- 2020
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33. Miscellaneous
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Navin Nanda, Smadar Kort, Rohit Tandon, N Alagic, M Elsayed, B Uygur, LG Adarna, JR Chahwala, K Bhagatwala, S Bulur, NSN Turaga, MJ Arisha, Sourabh Prabhakar, Robert Biederman, and Virginia Michelis
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- 2018
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34. Role of Echocardiography in Diagnosis of Constrictive Pericarditis: a Practical Summary
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Smadar Kort and Neda Dianati-Maleki
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Constrictive pericarditis ,medicine.medical_specialty ,Histology ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Restrictive cardiomyopathy ,Speckle tracking echocardiography ,Interventional radiology ,Cell Biology ,030204 cardiovascular system & hematology ,medicine.disease ,Applied Microbiology and Biotechnology ,Myocardial mechanics ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Myocardial strain ,cardiovascular system ,medicine ,Cardiology ,Circumferential strain ,030212 general & internal medicine ,Pericardiectomy ,business - Abstract
Constrictive pericarditis (CP) is an uncommon diagnosis in the modern day. Clinically, CP and restrictive cardiomyopathy can present in a similar fashion; however, differentiating the two entities is imperative since CP is potentially curable by pericardiectomy. In this manuscript, we aim to summarize echocardiographic characteristics of CP with a focus on parameters discriminating CP from restrictive cardiomyopathy (RCM). Classically, respiration-related interventricular septal shift and variations in mitral inflow and mitral annular velocities have been used to distinguish CP from RCM. Moreover, newer sophisticated echocardiography techniques including myocardial strain imaging by two-dimensional speckle tracking echocardiography (2D STE) have revolutionized our understanding of the myocardial mechanics in CP and RCM. Reduced circumferential strain in CP as well as reduced longitudinal strain in RCM has been shown to provide high sensitivity and specificity to differentiate the two clinical imitators. Echocardiography remains an important modality for diagnosing constrictive pericarditis. Advances in echocardiographic techniques have further improved the diagnostic ability of this imaging modality in diagnosing constriction and differentiating it from other clinically similar entities.
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- 2017
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35. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons
- Author
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John U, Doherty, Smadar, Kort, Roxana, Mehran, Paul, Schoenhagen, Prem, Soman, Greg J, Dehmer, Zahid, Amin, Thomas M, Bashore, Andrew, Boyle, Dennis A, Calnon, Blase, Carabello, Manuel D, Cerqueira, John, Conte, Milind, Desai, Daniel, Edmundowicz, Victor A, Ferrari, Brian, Ghoshhajra, Praveen, Mehrotra, Saman, Nazarian, T Brett, Reece, Balaji, Tamarappoo, Wendy S, Tzou, John B, Wong, Gregory J, Dehmer, Steven R, Bailey, Nicole M, Bhave, Alan S, Brown, Stacie L, Daugherty, Larry S, Dean, Milind Y, Desai, Claire S, Duvernoy, Linda D, Gillam, Robert C, Hendel, Christopher M, Kramer, Bruce D, Lindsay, Warren J, Manning, Manesh R, Patel, Ritu, Sachdeva, L Samuel, Wann, David E, Winchester, Michael J, Wolk, and Joseph M, Allen
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Echocardiography ,Angiography ,Cardiology ,Heart Valve Diseases ,Humans ,Magnetic Resonance Imaging, Cine ,Thoracic Surgery ,American Heart Association ,Tomography, X-Ray Computed ,Multimodal Imaging ,Societies, Medical ,United States - Abstract
This document is 1 of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. This document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas the second, companion document addresses this topic with regard to structural heart disease. Although there is clinical overlap, the documents addressing valvular and structural heart disease are published separately, albeit with a common structure. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of valvular and structural heart disease, encompassing multiple imaging modalities. Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association guidelines. A separate, independent rating panel scored the 92 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario. The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations where diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.
- Published
- 2017
36. CRT-700.11 Impact of Female Gender on 30-Day Outcomes Following Transcatheter Aortic Valve Replacement with Contemporary Valves
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Joanna Chikwe, Jonathan Weinstein, Ely Gracia, Daniel Montellese, Smadar Kort, Luis Gruberg, Javed Butler, Susan Callahan, Shamin Khan, Ting-Yu Wang, Thomas V. Bilfinger, Puja B. Parikh, Neal Patel, Giridhar Korlipara, and Henry Tannous
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0301 basic medicine ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Surgery ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Valve replacement ,030220 oncology & carcinogenesis ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
The impact of gender on early outcomes following transcatheter aortic valve replacement (TAVR) in the setting of contemporary valves is not well known. We aimed to evaluate gender-specific differences on 30-day outcomes in adults undergoing TAVR with contemporary valves. The study population
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- 2018
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37. CRT-700.34 Impact of Gender on Mortality in Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis
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Joanna Chikwe, Smadar Kort, Luis Gruberg, Ting-Yu Wang, Javed Butler, Allen Jeremias, and Puja B. Parikh
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medicine.medical_specialty ,Aortic valve replacement ,business.industry ,Meta-analysis ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Surgery - Abstract
Limited data exists regarding gender differences in outcomes following transcatheter (TAVR) and surgical aortic valve replacement (SAVR). We sought to review the published data and perform a systematic review to investigate differences in mortality between men and women following TAVR and SAVR. We
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- 2018
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38. CRT-700.04 Impact of Discharge Home without Home Services on 30-Day Outcomes Following Transcatheter Aortic Valve Replacement with Contemporary Valves
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Shamin Khan, Neal Patel, Joanna Chikwe, Henry Tannous, Javed Butler, Ely Gracia, Thomas V. Bilfinger, Susan Callahan, Smadar Kort, Daniel Montellese, Jonathan Weinstein, Giridhar Korlipara, Ting-Yu Wang, Puja B. Parikh, and Luis Gruberg
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medicine.medical_specialty ,Valve replacement ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Emergency medicine ,medicine ,Discharge home ,Cardiology and Cardiovascular Medicine ,business - Abstract
Medicare's Post-Acute Transfer (PACT) policy costs hospitals nationwide penalties following transcatheter aortic valve replacement. While discharging home without home services avoids PACT policy activation, its impact on 30-day outcomes following transcatheter aortic valve replacement (TAVR) is not
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- 2018
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39. TCT-22 Impact of Transcatheter Aortic Valve Implantation on Microemboli 24 to 48 h After Valve Implantation Observed as High-Intensity Transient Signals on Transcranial Doppler: Prevalence and Implications
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Ryan Heslin, Jeanwoo Yoo, Leyla Gasimli-Gamache, Thomas V. Bilfinger, John Medamana, Navneet Sharma, Robert Pyo, Puja B. Parikh, Jose Wiley, Joseph Burdowski, Saadat Aleem, Smadar Kort, Peter Avvento, Jahan E. Manjur, Nicos Labropoulos, and Henry Tannous
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medicine.medical_specialty ,High intensity transient signals ,Transcatheter aortic ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Transcranial Doppler - Published
- 2019
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40. Contributors
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Amr E. Abbas, Sahar S. Abdelmoneim, Theodore Abraham, Harry Acquatella, David B. Adams, Karima Addetia, Jonathan Afilalo, Vikram Agarwal, Yoram Agmon, Mohamed Ahmed, Carlos Alviar, Bonita Anderson, Edgar Argulian, Federico M. Asch, Gerard P. Aurigemma, Kelly Axsom, Luigi P. Badano, Revathi Balakrishnan, Sourin Banerji, Sripal Bangalore, Manish Bansal, Thomas Bartel, Rebecca Lynn Baumann, Helmut Baumgartner, Roy Beigel, J. Todd Belcik, Marek Belohlavek, Ricardo Benenstein, Eric Berkowitz, Nicole M. Bhave, Angelo Biviano, Nimrod Blank, Robert O. Bonow, Darryl J. Burstow, Benjamin Byrd, Scipione Carerj, John D. Carroll, Scott Chadderdon, Hari P. Chaliki, Kwan-Leung Chan, Farooq A. Chaudhry, Geoff Chidsey, Sofia Churzidse, Blai Coll, Vivian W. Cui, Maurizio Cusma-Picconne, Abdellaziz Dahou, Jacob P. Dal-Bianco, Daniel A. Daneshvar, Melissa A. Daubert, Ravin Davidoff, Jeanne M. DeCara, Antonia Delgado-Montero, Lisa Dellefave-Castillo, Ankit A. Desai, Kavit A. DeSouza, Bryan Doherty, Robert Donnino, Pamela S. Douglas, David M. Dudzinski, Raluca Dulgheru, Jean G. Dumesnil, Uri Elkayam, Raimund Erbel, Francine Erenberg, Arturo A. Evangelista, Steven B. Feinstein, Beatriz Ferreira, Elyse Foster, Benjamin H. Freed, Julius M. Gardin, Edward A. Gill, Linda Gillam, Steven Giovannone, Mark Goldberger, Steven A. Goldstein, John Gorcsan, Riccardo Gorla, Julia Grapsa, Erin S. Grawe, Christiane Gruner, Pooja Gupta, Swaminatha Gurudevan, Rebecca T. Hahn, Yuchi Han, Jennifer L. Hellawell, Samuel D. Hillier, Brian D. Hoit, Richard Humes, Vikrant Jagadeesan, Sonia Jain, Alexander Janosi, Peter A. Kahn, Sanjiv Kaul, Bijoy K. Khandheria, Gene H. Kim, Michael S. Kim, Bruce J. Kimura, Mary Etta King, Dmitry Kireyev, James N. Kirkpatrick, Allan L. Klein, Payal Kohli, Claudia E. Korcarz, Smadar Kort, Wojciech Kosmala, Konstantinos Koulogiannis, Ilias Koutsogeorgis, Frederick W. Kremkau, Eric V. Krieger, Itzhak Kronzon, Richard T. Kutnick, Wyman Lai, Stephane Lambert, Patrizio Lancellotti, Roberto M. Lang, Alex Pui-Wai Lee, Ming Sum Lee, Stamatios Lerakis, Jonathan Lessick, Steven J. Lester, Steve W. Leung, Florent LeVen, Robert A. Levine, Qin Li, Fabio Lima, Jonathan R. Lindner, Leo Lopez, Julien Magne, Haifa Mahjoub, Judy R. Mangion, Sunil V. Mankad, Dimitrios Maragiannis, Leo Marcoff, Randolph P. Martin, Thomas H. Marwick, Pierre Massabuau, Moses Mathur, Robert McCully, Edwin C. McGee, Elizabeth McNally, Sudhir Ken Mehta, Todd Mendelson, Issam A. Mikati, Karen Modesto, Mark Monaghan, Farouk Mookadam, Marie Moonen, Monica Mukherjee, Silvana Müller, Sharon L. Mulvagh, Denisa Muraru, Gillian Murtagh, Sherif F. Nagueh, Tasneem Z. Naqvi, Sandeep Nathan, Kazuaki Negishi, Petros Nihoyannopoulos, Vuyisile T. Nkomo, Erwin Oechslin, Joan Olson, John Palios, Gaurav Parikh, Amit R. Patel, Amit V. Patel, Aneet Patel, Anupa Patel, Timothy E. Paterick, Laila A. Payvandi, Gianni Pedrizzetti, Patricia A. Pellikka, Gila Perk, Ferande Peters, Dermot Phelan, Philippe Pibarot, Michael H. Picard, Juan Carlos Plana, Zoran B. Popovic, Thomas Porter, Shawn C. Pun, Atif N. Qasim, Nishath Quader, Miguel A. Quinones, Peter S. Rahko, Harry Rakowski, Rajeev V. Rao, Joseph Reiken, Shimon A. Reisner, Elizabeth M. Retzer, Vera H. Rigolin, David A. Roberson, Keith Rodgers, Damian Roper, Raphael Rosenhek, Eleanor Ross, R. Raina Roy, Frederick L. Ruberg, Lawrence G. Rudski, Carlos Ruiz, Ernesto E. Salcedo, Danita M. Yoerger Sanborn, Vrinda Sardana, Muhamed Saric, Nelson B. Schiller, Arend F.L. Schinkel, Shmuel S. Schwartzenberg, Partho P. Sengupta, Pravin M. Shah, Jack S. Shanewise, Stanton K. Shernan, Jeffrey A. Shih, Robert J. Siegel, Maithri Siriwardena, Samuel Siu, Scott D. Solomon, Vincent L. Sorrell, Kirk T. Spencer, Denise Spiegel, Martin St. John Sutton, James H. Stein, Kathleen Stergiopoulos, Azhar A. Supariwala, Paul E. Szmitko, Tanya H. Tajouri, Masaaki Takeuchi, Timothy C. Tan, James D. Thomas, Dennis A. Tighe, Maria C. Todaro, Albree Tower-Rader, Michael Y.C. Tsang, Teresa S.M. Tsang, Wendy Tsang, Paul A. Tunick, Philippe Vignon, Meagan M. Wafsy, Rachel Wald, R. Parker Ward, Nozomi Watanabe, Kevin Wei, Neil J. Weissman, Mariko Welsch, Susan Wiegers, Lynne Williams, Anna Woo, Chanwit Wuttichaipradit, Feng Xie, Teerapat Yingchoncharoen, Cheuk-Man Yu, Zoe Yu, Qiong Zhao, Concetta Zito, and William A. Zoghbi
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- 2016
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41. Evaluation of Cardiac Involvement with Mediastinal Lymphoma: The Role of Innovative Integrated Cardiovascular Imaging
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Hong Meng, Smadar Kort, Thomas Bilfinger, Mark Goldman, and Robert Matthews
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medicine.medical_specialty ,Chemotherapy ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Mediastinal mass ,medicine.disease ,Lymphoma ,medicine.anatomical_structure ,Mediastinal Lymphoma ,Positron emission tomography ,Cardiac magnetic resonance imaging ,Right heart ,medicine ,Pericardium ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 73-year-old woman presented in right heart failure. Computed tomography of the chest revealed a 3 cm × 5 cm anterior mediastinal mass. Contrast-enhanced two-dimensional transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), positron emission tomography (PET), and MRI-PET fusion demonstrated invasion of the pericardium and right heart by the tumor. Mediastinal biopsy revealed high-grade diffuse large B-cell lymphoma, which responded to chemotherapy. The role of each modality in this case was discussed in the manuscript. In conclusion, the integration of multiple imaging modalities is extremely useful in the characterization, localization, diagnosis and treatment of an unusual cardiac mass.
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- 2012
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42. Does the Revised Appropriate Use Criteria for Echocardiography Represent an Improvement Over the Initial Criteria? A Comparison between the 2011 and the 2007 Appropriateness Use Criteria for Echocardiography
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Smadar Kort, John Asheld, and Puja B. Parikh
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,New York ,MEDLINE ,Coronary Artery Disease ,Revascularization ,Tertiary care ,Appropriate Use Criteria ,Teaching hospital ,Coronary artery disease ,Internal medicine ,Prevalence ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,Aortic surgery ,medicine.disease ,Echocardiography ,Practice Guidelines as Topic ,Utilization Review ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The appropriateness use criteria (AUC) for the performance of transthoracic echocardiography were recently revised. The aims of this study were to evaluate the 2011 AUC for echocardiography for their ability to categorize indications not addressed by the older AUC and to identify trends in ordering unclassified and inappropriate studies when applying the new AUC. Methods We reviewed 384 consecutive adult transthoracic echocardiographic studies performed at a tertiary care teaching hospital. The appropriateness of each study was determined applying both the 2007 and the 2011 AUC. Results Among the 384 studies evaluated, 212 (55.2%) were performed in men, 261 (67.9%) were inpatient studies, and 186 (48.4%) were ordered by cardiologists. Compared with the older 2007 AUC, applying the new 2011 AUC demonstrated a lower rate of unclassified studies (5.5% vs 12.5%), higher rates of appropriate (92.2% vs 86.7%) and inappropriate (1.8% vs 0.8%) studies, and no significant change in the rate of uncertain studies (0.5% vs 0.0%). Of the 5.5% of studies that continued to be unclassified despite the application of the more extensive 2011 AUC, common indications included preoperative evaluation for non-transplantation surgery in patients with coronary artery disease, postoperative assessment of thoracic aortic surgery in the absence of any clinical change, and reassessment of ventricular function after revascularization in the absence of acute coronary syndromes. Conclusions Compared with the 2007 AUC for transthoracic echocardiography, application of the recently revised 2011 criteria leads to a significant decrease in the number of studies that are not classified, demonstrating that the AUC revision was successful in achieving the goal of addressing more clinical indications.
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- 2012
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43. Real Time Three-Dimensional Stress Echocardiography: A New Approach for Assessing Diastolic Function
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Swapna Mamidipally, David L. Brown, Smadar Kort, Siddharth K. Dave, and Purnema Madahar
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medicine.medical_specialty ,business.industry ,Diastole ,Stroke volume ,medicine.disease ,Blood pressure ,Internal medicine ,Heart rate ,medicine ,Cardiology ,Ventricular pressure ,Stress Echocardiography ,Radiology, Nuclear Medicine and imaging ,Diastolic function ,sense organs ,skin and connective tissue diseases ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Objective: To assess the feasibility of utilizing real time three-dimensional echocardiography (RT3DE) for assessment of diastolic function during stress. Methods: Rest and stress volumes were acquired in 24 patients and parameters of diastolic function—peak ventricular filling rate (PFR) and time to peak filling rate (TPFR)—were calculated. Results: Calculation of diastolic parameters was feasible in all patients. Resting PFR correlated with end-diastolic (EDV) and stroke volumes and inversely with TPFR (r = 0.53, 0.66, –0.5). With stress, PFR increased by 93% and TPFR decreased by 23% (P < 0.001). Stress PFR correlated with stress heart rate, EDV and stroke volume (r = 0.52, 0.50, 0.62) while TPFR correlated inversely with heart rate (r =–0.71). The change in PFR with stress correlated with the change in stroke volume (r = 0.42), while the change in TPFR correlated with the change in end-systolic volume (ESV) (r = 0.43) and inversely with the change in diastolic blood pressure (r =–0.41). Rest and stress PFR and TPFR are independent of age, gender and blood pressure and the change in PFR is independent of stress heart rate or blood pressure. E/E′ correlated with stress TPFR (r = 0.72) and change in TPFR (r = 0.67) and inversely with change in PFR (r =–0.67). Conclusions: RT3DE can assess diastolic function during stress by detecting changes in PFR and TPFR, independent of gender, age, and blood pressure. The changes in these parameters with stress are influenced by baseline filling pressures. Larger studies are required to validate the clinical significance of these observations. (Echocardiography 2011;28:676-683)
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- 2011
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44. Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and American College of Emergency Physicians
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Robert Jones, Steven A. Goldstein, Vivek S. Tayal, Kirk T. Spencer, Michelle Bierig, Thomas R. Porter, Vicki E. Noble, Smadar Kort, Kevin Wei, and Arthur J. Labovitz
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Chest Pain ,Thoracic Injuries ,Heart Ventricles ,Shock, Cardiogenic ,Specialty ,MEDLINE ,Cardiomegaly ,Sensitivity and Specificity ,Inferior vena cava ,Pericardial Effusion ,Diagnosis, Differential ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,Curriculum ,Societies, Medical ,Ultrasonography, Interventional ,Blood Volume ,business.industry ,Advanced cardiac life support ,Cardiac Pacing, Artificial ,Internship and Residency ,Pericardiocentesis ,Emergency department ,medicine.disease ,Triage ,United States ,Electrodes, Implanted ,Heart Arrest ,Dyspnea ,Radiology Information Systems ,Heart Injuries ,medicine.vein ,Echocardiography ,Education, Medical, Graduate ,Pulseless electrical activity ,Medical emergency ,Hypotension ,Emergency Service, Hospital ,Cardiology and Cardiovascular Medicine ,business ,Venous Pressure ,Heart Failure, Systolic - Abstract
The use of ultrasound has developed over the last 50 years into an indispensable first-line test for the cardiac evaluation of symptomatic patients. The technologic miniaturization and improvement in transducer technology, as well as the implementation of educational curriculum changes in residency training programs and specialty practice, have facilitated the integration of focused cardiac ultrasound into practice by specialties such as emergency medicine. In the emergency department, focused cardiac ultrasound has become a fundamental tool to expedite the diagnostic evaluation of the patient at the bedside and to initiate emergent treatment and triage decisions by the emergency physician.
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- 2010
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45. ATRIAL SEPTAL DEFECT DEVICE RELATED INFECTIVE ENDOCARDITIS IN A 20 WEEK PREGNANT FEMALE
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Joanna Chikwe, Roshini Malaney, Smadar Kort, Navneet Sharma, On Chen, and Paul Strachan
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medicine.medical_specialty ,business.industry ,Stroke prevention ,Infective endocarditis ,mental disorders ,Medicine ,cardiovascular diseases ,Closure (psychology) ,Pregnant female ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Surgery - Abstract
Atrial Septal Defect (ASD) closure device related infective endocarditis a year after implantation in a pregnant woman. 29 year old 20 week pregnant female s/p ASD closure a year ago for primary stroke prevention, presented with fever, and myalgias. She underwent dental cleanings while on
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- 2018
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46. CRT-700.15 Impact of Severity of Renal Dysfunction on 30-Day Readmission Following Transcatheter Aortic Valve Replacement with Contemporary Valves
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Daniel Montellese, Susan Callahan, Luis Gruberg, Shamin Khan, Puja B. Parikh, Thomas V. Bilfinger, Ely Gracia, Henry Tannous, Jonathan Weinstein, Joanna Chikwe, Giridhar Korlipara, Ting-Yu Wang, Smadar Kort, Javed Butler, and Neal Patel
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medicine.medical_specialty ,Valve replacement ,Transcatheter aortic ,business.industry ,Internal medicine ,medicine.medical_treatment ,medicine ,Cardiology ,Chronic renal disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
The impact of chronic renal disease on outcomes following transcatheter aortic valve replacement (TAVR) is not well known. Moreover, readmission rates following TAVR have not been adequately studied in the era of contemporary newer generation valves. We aimed to evaluate the impact of moderate and
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- 2018
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47. Moderate Pulmonary Arterial Hypertension in Male Mice Lacking the Vasoactive Intestinal Peptide Gene
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Sayyed A. Hamidi, James A. Waschek, Sergey Lyubsky, Anthony M. Szema, Smadar Kort, Kathleen G. Dickman, Sami I. Said, John J. Chen, Ya-Ping Jiang, and Richard Z. Lin
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Male ,Pathology ,medicine.medical_specialty ,Vascular smooth muscle ,Hypertension, Pulmonary ,Vasoactive intestinal peptide ,Blood Pressure ,Pulmonary Artery ,Muscle hypertrophy ,Mice ,Physiology (medical) ,medicine.artery ,medicine ,Animals ,Lung ,Ultrasonography ,Mice, Knockout ,Hypertrophy, Right Ventricular ,Ventricular Remodeling ,business.industry ,Gene Expression Profiling ,Respiratory disease ,medicine.disease ,Pulmonary hypertension ,Survival Rate ,Disease Models, Animal ,medicine.anatomical_structure ,Ventricle ,Gene Targeting ,Pulmonary artery ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,business ,Vasoactive Intestinal Peptide - Abstract
Background— Vasoactive intestinal peptide (VIP), a pulmonary vasodilator and inhibitor of vascular smooth muscle proliferation, has been reported absent in pulmonary arteries from patients with idiopathic pulmonary arterial hypertension (PAH). We have tested the hypothesis that targeted deletion of the VIP gene may lead to PAH with pulmonary vascular remodeling. Methods and Results— We examined VIP knockout (VIP −/− ) mice for evidence of PAH, right ventricular (RV) hypertrophy, and pulmonary vascular remodeling. Relative to wild-type control mice, VIP −/− mice showed moderate RV hypertension, RV hypertrophy confirmed by increased ratio of RV to left ventricle plus septum weight, and enlarged, thickened pulmonary artery and smaller branches with increased muscularization and narrowed lumen. Lung sections also showed perivascular inflammatory cell infiltrates. No systemic hypertension and no arterial hypoxemia existed to explain the PAH. The condition was associated with increased mortality. Both the vascular remodeling and RV remodeling were attenuated after a 4-week treatment with VIP. Conclusions— Deletion of the VIP gene leads to spontaneous expression of moderately severe PAH in mice during air breathing. Although not an exact model of idiopathic PAH, the VIP −/− mouse should be useful for studying molecular mechanisms of PAH and evaluating potential therapeutic agents. VIP replacement therapy holds promise for the treatment of PAH, and mutations of the VIP gene may be a factor in the pathogenesis of idiopathic PAH.
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- 2007
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48. Echocardiography in Acute Heart Failure: Current Perspectives
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Javed Butler, Lampros Papadimitriou, Andreas P. Kalogeropoulos, Vasiliki V. Georgiopoulou, and Smadar Kort
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Cardiac function curve ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Heart Failure ,business.industry ,Hemodynamics ,medicine.disease ,Prognosis ,Response to treatment ,Clinical trial ,Clinical Practice ,Hospitalization ,Patient classification ,Echocardiography ,Heart failure ,Risk stratification ,Acute Disease ,Practice Guidelines as Topic ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
In contrast to chronic heart failure (HF), the use of echocardiography in acute HF (AHF) is less well defined, both in clinical practice and in clinical trials. Current guidelines recommend the utility of echocardiography as an adjunct diagnostic tool in the clinical setting of new-onset or decompensated HF. However, despite its unique advantages as the only practical imaging modality in AHF, echocardiography poses unique challenges in this setting. Data from early-phase clinical studies and trials provide evidence that echocardiographic end points can be clinically meaningful surrogate end points as a means to track response to treatment in AHF; however, the optimal timing and selection of echocardiographic measures is under active investigation. In addition, despite a number of studies indicating that certain echocardiographic measures of cardiac function are predictive of post-discharge prognosis, the role of echocardiography as a tool for patient classification and risk determination in AHF is less well defined. Importantly, it is unclear whether echocardiography can be used to phenotype and select AHF patients for interventions. In this article, we (1) appraise the current evidence for use of echocardiographic measures in AHF, (2) identify knowledge gaps regarding optimal use of echocardiography in AHF, and (3) assess the evidence for echocardiography as a prognosis determination and risk stratification tool in AHF.
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- 2015
49. A Rare Case of Lactobacillus acidophilus Presenting as Mitral Valve Bacterial Endocarditis
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Rebecca T. Hahn, Smadar Kort, Amgad N. Makaryus, and Rayson Yang
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Female circumcision ,Flora ,medicine.medical_specialty ,Pathology ,biology ,business.industry ,food and beverages ,biology.organism_classification ,medicine.disease ,Gastroenterology ,Lactobacillus acidophilus ,medicine.anatomical_structure ,Bacterial endocarditis ,Lactobacillus ,Internal medicine ,Mitral valve ,Rare case ,medicine ,Endocarditis ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
Lactobacillus acidophilus is a gram-positive rod that is a commensal of human mucosal tissues. They are usually considered nonpathogenic flora of the mouth, gut, and female genital tract. Lactobacillus is a rare cause of endocarditis with less than 50 cases reported in the world literature to date. We report the case of a 63-year-old woman who developed native mitral valve endocarditis secondary to L. acidophilus, and examine the literature regarding this rare entity.
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- 2005
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50. Contrast Echocardiography Improves the Diagnostic Yield of Transthoracic Studies Performed in the Intensive Care Setting by Novice Sonographers
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Linda D. Gillam, Lawrence M. Phillips, Safi Ahmed, David Friedman, David A. Rosman, Amgad N. Makaryus, Cristina Sison, Michael E. Zubrow, Judy R. Mangion, Nickolaos Michelakis, and Smadar Kort
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Male ,medicine.medical_specialty ,Heart Diseases ,Point-of-Care Systems ,Ventricular Dysfunction, Left ,Intensive care ,Image Processing, Computer-Assisted ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Left ventricular wall motion ,Ventricular function ,business.industry ,Internship and Residency ,Retrospective cohort study ,Middle Aged ,Intensive Care Units ,Exact test ,Echocardiography ,Clinical question ,Contrast echocardiography ,Female ,Clinical Competence ,Level iii ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Bedside portable echocardiography in the intensive care department (ICU) is technically difficult, but crucial for directing patient care. Prior studies have shown contrast echocardiography (CE) in the ICU clarifies left ventricular wall motion when performed by experienced sonographers (ESO). However, in most hospitals, ESO are unavailable around the clock, and less experienced cardiovascular fellows or trainees may be asked to perform these examinations. Methods Transthoracic echocardiograms were retrospectively evaluated by level III trained echocardiographers for 213 patients in the ICU. Most were performed to assess left ventricular function (65% or 139 of 213) and were scanned by cardiology fellows (70% or 149 of 213) with less than 3 months echocardiography experience. Contrast agent was used in 29% (62 of 213) of all patients. Results The conversion of suboptimal or diagnostically inadequate apical 4- and 2-chamber views to diagnostically adequate with contrast was statistically significant when performed by both cardiology fellows and ESO (Fischer exact test, P Conclusions CE is effective in improving the diagnostic yield of transthoracic echocardiographic ICU studies performed by both novice sonographers and ESO. Using cardiology fellows to perform CE in this setting can be appropriate, particularly in after-hour situations, when ESO are not always available and the clinical question is left ventricular function. Results also suggest cardiology fellows can easily learn CE.
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- 2005
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