48 research outputs found

    Cardiovascular Imaging in Pregnancy: Valvulopathy, Hypertrophic Cardiomyopathy, and Aortopathy

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    Pregnancy is associated with profound hemodynamic changes that are particularly impactful in patients with underlying cardiovascular disease. Management of pregnant women with cardiovascular disease requires careful evaluation that considers the well-being of both the woman and the developing fetus. Clinical assessment begins before pregnancy and continues throughout gestation into the post-partum period and is supplemented by cardiac imaging. This review discusses the role of imaging, specifically echocardiography, cardiac MRI, and cardiac CT, in pregnant women with valvular diseases, hypertrophic cardiomyopathy, and aortic pathology

    Artificial Intelligence Advancements in the Cardiovascular Imaging of Coronary Atherosclerosis

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    Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advancements in the field of cardiovascular imaging to aid in diagnosis, treatment, and prevention of coronary artery disease. The application of artificial intelligence in medicine, particularly in cardiovascular medicine has erupted in the past decade. This article serves to highlight the highest yield articles within cardiovascular imaging with an emphasis on coronary CT angiography methods for % stenosis evaluation and atherosclerosis quantification for the general cardiologist. The paper finally discusses the evolving paradigm of implementation of artificial intelligence in real world practice

    Make the Call, Don\u27t Miss a Beat Campaign: Effect on Emergency Medical Services Use in Women with Heart Attack Signs.

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    © 2019 Jacobs Institute of Women\u27s Health Background: Our objective was to evaluate the relationship between the “Make The Call, Don\u27t Miss a Beat” national mass media campaign and emergency medical services (EMS) use among women with possible heart attack symptoms. Methods: We linked campaign TV public service advertisement data with national EMS activation data for 2010 to 2014. We identified EMS activations (i.e., responses) for possible heart attack symptoms and for unintentional injuries for both women and men. We estimated the impact of the campaign on the fraction of the 1.7 to 15.9 million activations of women with possible heart attack symptoms compared with 1.9 million female activations for unintentional injuries within each EMS agency and month using quasi-binomial logistic regression controlling for time and state. Results: Of the 3,175 U S. counties, 90% were exposed to the campaign. However, less than 2% of U.S. counties reached moderate TV exposure (≥300 gross rating points) during the entire campaign period. We did not observe an increase in the fraction of female activations for possible heart attack during periods or in counties with higher campaign exposure. Conclusions: This mass media campaign that relied heavily on TV public service advertisements was not associated with increased EMS use by women with possible heart attack symptoms, even among counties that were more highly exposed to the campaign advertisements

    Transcatheter Aortic Valve Replacement Improves Right Ventricular Hemodynamics in High Surgical Risk Patients with Aortic Stenosis

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    Introduction Aortic stenosis (AS) affects between 3-23% of elderly adults and is a major cause of morbidity and mortality. While surgical aortic valve replacement had been associated with prohibitive risk for many of these patients, transcatheter aortic valve replacement (TAVR) represents an emerging alternative approach. The hemodynamic efficacy of TAVR has been demonstrated in clinical trials; however, less is known in real- world practice. Specifically, AS worsens right ventricular function and pulmonary hypertension that may be associated with adverse outcomes. The goal of this study was to assess whether TAVR results in improvement of RV hemodynamics as measured by echocardiography. Methods We reviewed 62 patients referred for TAVR to an urban academic medical center from 2014-2016. Transthoracic echocardiography (TTE) was performed before and after TAVR according to American Society of Echocardiography guidelines. Pre-TAVR and post-TAVR TTE were reviewed at blinded separate sessions. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and tissue Doppler-derived tricuspid lateral annular systolic velocity (S’). RV size was quantified as the basal diameter in the apical four-chamber view. Pulmonary artery pressure was derived using tricuspid regurgitation velocity + right atrial pressure, with pulmonary artery hypertension defined as \u3e 40 mm Hg. Left heart hemodynamics were also assessed using standard measures. Results The study included 29 patients with fully retrievable TTE imaging available for review. Mean age was 79 ± 9.2 years (range 63-94), 70% were men, and all were at high surgical risk (STS Score 7.1 ± 5.3, 33% hostile chest). Of the 29, 9 (31%) had mild to moderate chronic lung disease. RV size and FAC were similar pre and post TAVR. Significantly, TAVR resulted in improvement in pulmonary pressure in 14 patients (48% p=0.03), and RV function by TAPSE in 9 patients (p=0.03) and S’ in 9 patients (p=0.02). 27/29 (93%) of patients demonstrated no or trace aortic insufficiency after TAVR. Regarding the left heart, TAVR also significantly improved left ventricular ejection Fraction in 21 patients (72%; p=0.004), aortic valve peak velocity in all 29 patients (p\u3c0.001) and aortic valve mean gradient in all 29 patients (p \u3c0.001). Conclusion In this real-world cohort, TAVR resulted in improvement in pulmonary hypertension and RV function. As pulmonary hypertension has been associated with worse outcomes, our data suggests that further studies are needed to determine whether these improvements observed are predictive of better long-term outcomes. **This abstract was also accepted as a poster presentation to the 2017 American College of Physician Internal Medicine Meeting

    Estimation of right atrial and ventricular hemodynamics by CT coronary angiography.

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    BACKGROUND: Computed tomography coronary angiography (CTCA) provides an accurate noninvasive alternative to the invasive assessment of coronary artery disease. However, a specific limitation of CTCA is inability to assess hemodynamic data. OBJECTIVE: We hypothesized that CTCA-derived measurements of contrast within the superior vena cava (SVC) and inferior vena cava (IVC) would correlate to echocardiographic estimations of right atrial and right ventricular pressures. METHODS: Medical records of all patients who underwent both echocardiography and CTCA in our center were reviewed (n = 32). Standard CTCA was performed with a 64-detector CT using test-bolus method for image acquisition timing and iso-osmolar contrast injection through upper extremity vein. The length of the column of contrast reflux into the inferior vena cava (IVC) was correlated to echocardiographically determine tricuspid regurgitation jet velocity (TRV). SVC area change with contrast injection at the level of the bifurcation of the pulmonary artery was also correlated with IVC sniff response by echocardiogram. RESULTS: The reflux column length was interpretable in 27 of 32 patients with a mean length of 10.1 ± 1.1 mm, and a significant bivariate correlation was observed between reflux column length and the tricuspid regurgitant jet velocity (r = 0.84; P \u3c .0001). Mean SVC distensibility ratio was 0.63 ± 0.03; mean IVC sniff response ratio was 0.53 ± 0.03. SVC distensibility correlated to IVC sniff response with a Pearson r of 0.57 (P = .04). CONCLUSION: Quantification of IVC and SVC contrast characteristics during CTCA provides a feasible and potentially accurate method of estimating right atrial and ventricular pressure
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