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46 results on '"Prasad, Sandhir B."'

2. Novel combined echocardiographic score comprising prognostically validated measures of left ventricular size and function to predict long‐term survival following myocardial infarction: A proposal to improve risk stratification.

Author

Prasad, Sandhir B., Chan, Nicole Ivy, Krishnan, Anish, Martin, Paul, Stewart, Peter, Mallouhi, Michael, Vollbon, William, and Atherton, John J.

Subjects
*MYOCARDIAL infarction, *LEFT heart ventricle, *RISK assessment, *VENTRICULAR ejection fraction, *RESEARCH funding, *NON-ST elevated myocardial infarction, *RECEIVER operating characteristic curves, *HEART physiology, *RETROSPECTIVE studies, *MULTIVARIATE analysis, *DESCRIPTIVE statistics, *MEDICAL records, *ACQUISITION of data, *STATISTICS, *ECHOCARDIOGRAPHY, *PROPORTIONAL hazards models, *ST elevation myocardial infarction, MORTALITY risk factors
Abstract

Background: While left ventricular ejection fraction (LVEF) is the primary variable utilized for prognosis following myocardial infarction (MI), it is relatively indiscriminate for survival in patients with mildly reduced (> 40%) or preserved LVEF (> 50%). Improving risk stratification in patients with mildly reduced or preserved LVEF remains an unmet need, and could be achieved by using a combination approach using prognostically validated measures of left‐ventricular (LV) size, geometry, and function. Aims: The aim of this study was to compare the prognostic utility of a Combined Echo‐Score for predicting all‐cause (ACM) and cardiac mortality (CM) following MI to LVEF alone, including the sub‐groups with LVEF > 40% and LVEF > 50%. Methods: Retrospective data on 3094 consecutive patients with MI from 2013 to 2021 who had inpatient echocardiography were included, including both patients with ST‐elevation MI (n = 869 [28.1%]) and non‐ST‐elevation MI (n = 2225 [71.9%]). Echo‐Score consisted of LVEF < 40% (2 points) or LVEF < 50% (1 point), and 1 point each for left atrial volume index > 34 mL/m2, septal E/eʹ > 15, abnormal LV mass‐index, tricuspid regurgitation velocity > 2.8 m/s, and abnormal LV end‐systolic volume‐index. Simple addition was used to derive a score out of 7. Results: At a median follow‐up of 4.5 years there were 445 deaths (130 cardiac deaths). On Cox proportional‐hazards multivariable analysis incorporating significant clinical and echocardiographic predictors, Echo‐Score was an independent predictor of both ACM (HR 1.34, p <.001) and CM (HR 1.59, p <.001). Inter‐model comparisons of model 훘2, Harrel's C and Somer's D, and Receiver operating curves confirmed the superior prognostic value of Echo‐Score for both endpoints compared to LVEF. In the subgroups with LVEF > 40% and LVEF > 50%, Echo‐Score was similarly superior to LVEF for predicting ACM and CM. Conclusions: An Echo‐Score composed of prognostically validated LV parameters is superior to LVEF alone for predicting survival in patients with MI, including the subgroups with mildly reduced and preserved LVEF. This could lead to improved patient risk stratification, better‐targeted therapies, and potentially more efficient use of device therapies. Further studies should be considered to define the benefit of further investigation and treatment in high‐risk subgroups. [ABSTRACT FROM AUTHOR]

Published
2024
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35. Evaluation of training nurses to perform semi-automated three-dimensional left ventricular ejection fraction using a customised workstation-based training protocol

Author

Guppy-Coles, Kristyan B., Prasad, Sandhir B., Smith, Kym C., Hillier, Samuel, Lo, Ada, Atherton, John J., Guppy-Coles, Kristyan B., Prasad, Sandhir B., Smith, Kym C., Hillier, Samuel, Lo, Ada, and Atherton, John J.

Abstract

Aims and Objectives: We aimed to determine the feasibility of training cardiac nurses to evaluate left ventricular function utilising a semi-automated, workstation-based protocol on three dimensional echocardiography images. Background: Assessment of left ventricular function by nurses is an attractive concept. Recent developments in three dimensional echocardiography coupled with border detection assistance have reduced inter- and intra-observer variability and analysis time. This could allow abbreviated training of nurses to assess cardiac function. Design: A comparative, diagnostic accuracy study evaluating left ventricular ejection fraction assessment utilising a semi-automated, workstation-based protocol performed by echocardiography-naïve nurses on previously acquired three dimensional echocardiography images. Methods: Nine cardiac nurses underwent two brief lectures about cardiac anatomy, physiology and three dimensional left ventricular ejection fraction assessment, before a hands-on demonstration in 20 cases. We then selected 50 cases from our three dimensional echocardiography library based on optimal image quality with a broad range of left ventricular ejection fractions, which was quantified by two experienced sonographers and the average used as the comparator for the nurses. Nurses independently measured three dimensional left ventricular ejection fraction using the Auto lvq package with semi-automated border detection. Results: The left ventricular ejection fraction range was 25-72% (70% with a left ventricular ejection fraction <55%). All nurses showed excellent agreement with the sonographers. Minimal intra-observer variability was noted on both short-term (same day) and long-term (>2 weeks later) retest. Conclusions: It is feasible to train nurses to measure left ventricular ejection fraction utilising a semi-automated, workstation-based protocol on previously acquired three dimensional echocardiography images. Further study is needed to determi

Published
2015

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