227 results on '"Bonow, Ro"'
Search Results
2. PCI and CABG for Treating Stable Coronary Artery Disease JACC Review Topic of the Week
- Author
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Doenst, T, Haverich, A, Serruys, PWJC, Bonow, RO, Kappetein, Arie-Pieter, Falk, V, Velazquez, E, Diegeler, A, Sigusch, H, and Cardiothoracic Surgery
- Published
- 2019
3. Impact of Diabetes on Epidemiology, Treatment, and Outcomes of Patients With Heart Failure
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Dei Cas, A, Khan, S, Butler, J, Mentz, R, Bonow, R, Avogaro, A, Tschoepe, D, Doehner, W, Greene, S, Senni, M, Gheorghiade, M, Fonarow, G, Dei Cas A, Khan SS, Butler J, Mentz RJ, Bonow RO, Avogaro A, Tschoepe D, Doehner W, Greene SJ, Senni M, Gheorghiade M, Fonarow GC, Dei Cas, A, Khan, S, Butler, J, Mentz, R, Bonow, R, Avogaro, A, Tschoepe, D, Doehner, W, Greene, S, Senni, M, Gheorghiade, M, Fonarow, G, Dei Cas A, Khan SS, Butler J, Mentz RJ, Bonow RO, Avogaro A, Tschoepe D, Doehner W, Greene SJ, Senni M, Gheorghiade M, and Fonarow GC
- Abstract
The prevalence of patients with concomitant heart failure (HF) and diabetes mellitus (DM) continues to increase with the general aging of the population. In patients with chronic HF, prevalence of DM is 24% compared with 40% in those hospitalized with worsening HF. Patients with concomitant HF and DM have diverse pathophysiologic, metabolic, and neurohormonal abnormalities that potentially contribute to worse outcomes than those without comorbid DM. In addition, although stable HF outpatients with DM show responses that are similar to those of patients without DM undergoing evidence-based therapies, it is unclear whether hospitalized HF patients with DM will respond similarly to novel investigational therapies. These data support the need to re-evaluate the epidemiology, pathophysiology, and therapy of HF patients with concomitant DM. This paper discusses the role of DM in HF patients and underscores the potential need for the development of targeted therapies.
- Published
- 2015
4. Acute Myocardial Infarction Admissions During the COVID-19 Peak.
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Guduguntla V, Bonow RO, and Yancy CW
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- Humans, Male, Female, Aged, Middle Aged, Hospitalization statistics & numerical data, SARS-CoV-2, Patient Admission statistics & numerical data, COVID-19 epidemiology, Myocardial Infarction epidemiology
- Published
- 2024
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5. Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis.
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Mehta CK, Liu TX, Bonnell L, Habib RH, Kaneko T, Flaherty JD, Davidson CJ, Thomas JD, Rigolin VH, Bonow RO, Pham DT, Johnston DR, McCarthy PM, and Malaisrie SC
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- Humans, Aged, Male, Female, Aged, 80 and over, Age Factors, Middle Aged, Aortic Valve surgery, Aortic Valve abnormalities, Retrospective Studies, Treatment Outcome, Postoperative Complications epidemiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Heart Valve Prosthesis Implantation methods
- Abstract
Background: The management of aortic stenosis has evolved to stratification by age as reflected in recent societal guidelines. We evaluated age-stratified surgical aortic valve replacement (SAVR) trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database., Methods: This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated., Results: In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14)., Conclusions: SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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6. Osteosarcopenia and Mortality After Transcatheter Aortic Valve Replacement.
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O'Gara PT, Guduguntla V, and Bonow RO
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- Humans, Male, Female, Aged, 80 and over, Aged, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Aortic Valve Stenosis complications, Sarcopenia complications
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- 2024
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7. Management Challenges for Bioprosthetic Aortic Valve Failure.
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Guduguntla V and Bonow RO
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- Humans, Heart Valve Prosthesis Implantation methods, Reoperation, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Prosthesis Failure, Aortic Valve surgery
- Published
- 2024
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8. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures.
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, and Szerlip M
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- Adult, United States, Humans, Quality Indicators, Health Care, American Heart Association, Cardiology, Heart Diseases, Cardiovascular System
- Published
- 2024
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9. Advancing Equity at the JAMA Network-Self-Reported Demographics of Editors and Editorial Board Members.
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Bibbins-Domingo K, Flanagin A, Sietmann C, Bonow RO, Navar AM, Shinkai K, Roberson ML, Ayanian JZ, Ponce N, Inouye SK, Durant RW, Simon MA, Rivara FP, Vela M, Josephson SA, Rawls A, Disis MLN, Florez N, Bressler NM, Scott AW, Piccirillo JF, Osazuwa-Peters N, Christakis DA, Duncan AF, Öngür D, Bagot KS, Kibbe MR, Backhus LM, and Malani PN
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- Humans, Demography, Self Report
- Published
- 2024
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10. High-Sensitivity Troponin in Pulmonary Embolism Risk Stratification-Proceed With Caution.
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Guduguntla V and Bonow RO
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- Humans, Prognosis, Risk Assessment, Troponin, Pulmonary Embolism diagnosis
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- 2024
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11. Degenerative mitral regurgitation.
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Delgado V, Ajmone Marsan N, Bonow RO, Hahn RT, Norris RA, Zühlke L, and Borger MA
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- Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Echocardiography, Treatment Outcome, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency surgery, Cardiac Surgical Procedures methods
- Abstract
Degenerative mitral regurgitation is a major threat to public health and affects at least 24 million people worldwide, with an estimated 0.88 million disability-adjusted life years and 34,000 deaths in 2019. Improving access to diagnostic testing and to timely curative therapies such as surgical mitral valve repair will improve the outcomes of many individuals. Imaging such as echocardiography and cardiac magnetic resonance allow accurate diagnosis and have provided new insights for a better definition of the most appropriate timing for intervention. Advances in surgical techniques allow minimally invasive treatment with durable results that last for ≥20 years. Transcatheter therapies can provide good results in select patients who are considered high risk for surgery and have a suitable anatomy; the durability of such repairs is up to 5 years. Translational science has provided new knowledge on the pathophysiology of degenerative mitral regurgitation and may pave the road to the development of medical therapies that could be used to halt the progression of the disease., (© 2023. Springer Nature Limited.)
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- 2023
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12. Realigning Priorities in the Evaluation and Management of Patients With Heart Failure.
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Udelson JE, Fonarow GC, and Bonow RO
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- Humans, Myocardium, Patients, Heart Failure diagnosis, Heart Failure therapy, Myocardial Ischemia, Cardiomyopathies
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- 2023
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13. Regulatory Oversight of Cardiovascular Devices-Why We Care.
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Yancy CW, O'Gara PT, and Bonow RO
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- Humans, Heart, Cardiovascular System
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- 2023
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14. Imaging Methods for Evaluation of Chronic Aortic Regurgitation in Adults: JACC State-of-the-Art Review.
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Ranard LS, Bonow RO, Nishimura R, Mack MJ, Thourani VH, Bavaria J, O'Gara PT, Bax JJ, Blanke P, Delgado V, Leipsic J, Lang RM, Michelena HI, Cavalcante JL, Vahl TP, Leon MB, and Rigolin VH
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- Humans, Adult, Aortic Valve diagnostic imaging, Echocardiography, Magnetic Resonance Imaging, Aortic Valve Insufficiency diagnostic imaging
- Abstract
A global multidisciplinary workshop was convened to discuss the multimodality diagnostic evaluation of aortic regurgitation (AR). Specifically, the focus was on assessment tools for AR severity and analyzing evolving data on the optimal timing of aortic valve intervention. The key concepts from this expert panel are summarized as: 1) echocardiography is the primary imaging modality for assessment of AR severity; however, when data is incongruent or incomplete, cardiac magnetic resonance may be helpful; 2) assessment of left ventricular size and function is crucial in determining the timing of intervention; 3) recent evidence suggests current cutpoints for intervention in asymptomatic severe AR patients requires further scrutiny; 4) left ventricular end-systolic volume index has emerged as an additional parameter that has promise in guiding timing of intervention; and 5) the role of additional factors (including global longitudinal strain, regurgitant fraction, and myocardial extracellular volume) is worthy of future investigation., Competing Interests: Funding Support and Author Disclosures Dr Ranard has received institutional funding to Columbia University from Boston Scientific. Dr Bax has received speaker bureau fees from Abbott and Edwards Lifesciences. Dr Delgado has received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, Medtronic, Novartis, and Philips; and has received consulting fees from Edwards Lifesciences and Novo Nordisk. Dr Leipsic has received institutional CT core lab contracts with Edwards Lifesciences, Abbott, Boston Scientific, Medtronic, and PI Cardia. Dr Lang is on the Speakers Bureau and has received grants from Philips Medical Systems. Dr Vahl has received institutional funding to Columbia University Irving Medical Center from Boston Scientific, Edwards Lifesciences, JenaValve, Medtronic, and Siemens Healthineers; and has personally received consulting fees from 4C Medical, Abbott Vascular, and Boston Scientific. Dr Leon has received institutional clinical research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and JenaValve. Dr Rigolin has stock ownership in Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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15. Long-Term Efficacy and Safety of Mavacamten in Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy.
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Day SM, Udelson JE, and Bonow RO
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- 2023
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16. Aortic Regurgitation and Heart Failure: Advances in Diagnosis, Management, and Interventions.
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Peigh G, Puthumana JJ, and Bonow RO
- Subjects
- Humans, Aortic Valve surgery, Treatment Outcome, Aortic Valve Insufficiency complications, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency surgery, Heart Failure therapy, Heart Failure surgery, Aortic Valve Stenosis, Heart Valve Prosthesis Implantation methods
- Abstract
This review discusses the contemporary clinical evaluation and management of patients with comorbid aortic regurgitation (AR) and heart failure (HF) (AR-HF). Importantly, as clinical HF exists along the spectrum of AR severity, the present review also details novel strategies to detect early signs of HF before the clinical syndrome ensues. Indeed, there may be a vulnerable cohort of AR patients who benefit from early detection and management of HF. Additionally, while the mainstay of operative management for AR has historically been surgical aortic valve replacement, this review discusses alternate procedures that may be beneficial in high-risk cohorts., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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17. The contribution of amyloid deposition in the aortic valve to calcification and aortic stenosis.
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Sud K, Narula N, Aikawa E, Arbustini E, Pibarot P, Merlini G, Rosenson RS, Seshan SV, Argulian E, Ahmadi A, Zhou F, Moreira AL, Côté N, Tsimikas S, Fuster V, Gandy S, Bonow RO, Gursky O, and Narula J
- Subjects
- Humans, Aortic Valve pathology, Plaque, Amyloid complications, Plaque, Amyloid pathology, Aortic Valve Stenosis genetics, Calcinosis genetics
- Abstract
Calcific aortic valve disease (CAVD) and stenosis have a complex pathogenesis, and no therapies are available that can halt or slow their progression. Several studies have shown the presence of apolipoprotein-related amyloid deposits in close proximity to calcified areas in diseased aortic valves. In this Perspective, we explore a possible relationship between amyloid deposits, calcification and the development of aortic valve stenosis. These amyloid deposits might contribute to the amplification of the inflammatory cycle in the aortic valve, including extracellular matrix remodelling and myofibroblast and osteoblast-like cell proliferation. Further investigation in this area is needed to characterize the amyloid deposits associated with CAVD, which could allow the use of antisense oligonucleotides and/or isotype gene therapies for the prevention and/or treatment of CAVD., (© 2023. Springer Nature Limited.)
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- 2023
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18. Author Correction: The contribution of amyloid deposition in the aortic valve to calcification and aortic stenosis.
- Author
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Sud K, Narula N, Aikawa E, Arbustini E, Pibarot P, Merlini G, Rosenson RS, Seshan SV, Argulian E, Ahmadi A, Zhou F, Moreira AL, Côté N, Tsimikas S, Fuster V, Gandy S, Bonow RO, Gursky O, and Narula J
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- 2023
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19. Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation.
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Malahfji M, Crudo V, Kaolawanich Y, Nguyen DT, Telmesani A, Saeed M, Reardon MJ, Zoghbi WA, Polsani V, Elliott M, Bonow RO, Graviss EA, Kim R, and Shah DJ
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- Humans, Middle Aged, Ventricular Function, Left, Stroke Volume, Ventricular Remodeling, Aortic Valve surgery, Retrospective Studies, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery, Aortic Valve Insufficiency complications
- Abstract
Background: Quantitative cardiac magnetic resonance (CMR) outcome studies in aortic regurgitation (AR) are few. It is unclear if volume measurements are beneficial over diameters., Objectives: This study sought to evaluate the association of CMR quantitative thresholds and outcomes in AR patients., Methods: In a multicenter study, asymptomatic patients with moderate or severe AR on CMR with preserved left ventricular ejection fraction (LVEF) were evaluated. Primary outcome was development of symptoms or decrease in LVEF to <50%, development of guideline indications for surgery based on LV dimensions, or death under medical management. Secondary outcome was the same as the primary outcome, excluding surgery for remodeling indications. We excluded patients who underwent surgery within 30 days of CMR. Receiver-operating characteristic analyses for the association with outcomes were performed., Results: We studied 458 patients (median age: 60 years; IQR: 46-70 years). During a median follow-up of 2.4 years (IQR: 0.9-5.3 years), 133 events occurred. Optimal thresholds were regurgitant volume of 47 mL and regurgitant fraction of 43%, indexed LV end-systolic (iLVES) volume of 43 mL/m
2 , indexed LV end-diastolic volume of 109 mL/m2 , and iLVES diameter of 2 cm/m2 . In multivariable regression analysis, iLVES volume of ≥43 mL/m2 (HR: 2.53; 95% CI: 1.75-3.66; P < 0.001) and indexed LV end-diastolic volume of ≥109 mL/m2 were independently associated with the outcomes and provided additional discrimination improvement over iLVES diameter, whereas iLVES diameter was independently associated with the primary outcome but not the secondary outcome., Conclusions: In asymptomatic AR patients with preserved LVEF, CMR findings can be used to guide management. CMR-based LVES volume assessment performed favorably compared to LV diameters., Competing Interests: Funding Support and Author Disclosures This research was conducted using the SCMR Registry Resource. Dr Malahfji has received research support from the Houston Methodist Research Institute and Guerbet LLC. Dr Reardon is a consultant to Medtronic, Boston Scientific, Abbott Medical, and Gore Medical. Dr Shah has received support from the National Science Foundation (CNS-1931884) and the Beverly B. and Daniel C. Arnold Distinguished Centennial Chair Endowment. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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20. Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease: A Review.
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Baman JR, Medhekar AN, Malaisrie SC, McCarthy P, Davidson CJ, and Bonow RO
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- Pregnancy, Female, Young Adult, Humans, Aged, Aortic Valve surgery, Anticoagulants therapeutic use, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis, Aortic Valve Insufficiency surgery
- Abstract
Importance: The management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age <65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors., Observations: Traditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options., Conclusions and Relevance: The management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.
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- 2023
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21. Public Access to Scientific Research Findings and Principles of Biomedical Research-A New Policy for the JAMA Network.
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Bibbins-Domingo K, Shields B, Ayanian JZ, Bonow RO, Bressler NM, Christakis D, Disis ML, Josephson SA, Kibbe MR, Öngür D, Piccirillo JF, Redberg RF, Rivara FP, Shinkai K, and Easley TJ
- Subjects
- Humans, Policy, Biomedical Research
- Published
- 2023
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22. Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects.
- Author
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Weiss EK, Jarvis K, Maroun A, Malaisrie SC, Mehta CK, McCarthy PM, Bonow RO, Avery RJ, Allen BD, Carr JC, Rigsby CK, and Markl M
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- Humans, Cross-Sectional Studies, Retrospective Studies, Dilatation, Predictive Value of Tests, Aortic Valve diagnostic imaging, Aortic Valve pathology, Hemodynamics, Magnetic Resonance Spectroscopy, Bicuspid Aortic Valve Disease, Heart Valve Diseases complications, Heart Valve Diseases diagnostic imaging, Aortic Valve Stenosis pathology, Aortic Diseases complications, Aortic Valve Insufficiency
- Abstract
Background: Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole., Methods: 510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole., Results: BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1)., Conclusion: 4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies., (© 2023. The Author(s).)
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- 2023
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23. Public Access to Scientific Research Findings and Principles of Biomedical Research-A New Policy for the JAMA Network.
- Author
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Bibbins-Domingo K, Shields B, Ayanian JZ, Bonow RO, Bressler NM, Christakis D, Disis ML, Josephson SA, Kibbe MR, Öngür D, Piccirillo JF, Redberg RF, Rivara FP, Shinkai K, and Easley TJ
- Subjects
- Policy, Biomedical Research
- Published
- 2022
- Full Text
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24. Fate of moderate aortic regurgitation after cardiac surgery.
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Ward A, Malaisrie SC, Andrei AC, Bonow RO, Thomas JD, Puthumana J, Pham DT, Churyla A, Kruse J, and McCarthy PM
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- Humans, Aortic Valve diagnostic imaging, Aortic Valve surgery, Treatment Outcome, Retrospective Studies, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency epidemiology, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery, Heart Valve Diseases surgery, Cardiac Surgical Procedures adverse effects
- Abstract
Objective: To determine the prevalence of concomitant aortic regurgitation (AR) in cardiac surgery and the outcomes of treatment options., Methods: Between April 2004 and June 2018, 3289 patients underwent coronary artery bypass, mitral valve, or aortic aneurysm surgery without aortic stenosis. AR was graded none/trivial (score = 0), mild (score = 1+), or moderate (score = 2+). Patients with untreated 2+ AR were compared with those with 0 or 1+ AR, and to those with 2+ AR who had aortic valve surgery. Thirty-day and late survival, echocardiography, and clinical outcomes were compared using propensity score matching., Results: One hundred thirty-eight patients (4.2%) had 2+ AR; and 45 (33%) received aortic valve repair (n = 9) or replacement (n = 36) in the treated group and were compared with 2765 untreated patients with 0 AR and 386 patients with 1+ AR. Valve surgery was more common with anatomic leaflet abnormalities: bicuspid aortic valve (9% vs 0%; P < .01), rheumatic valve disease (16% vs 3%; P < .01), and calcification (47% vs 27%; P = .021). In unadjusted analysis, lower preoperative AR grade was associated with increased 10-year survival (P < .001). At year 10, progression to more-than-moderate AR among moderate AR patients was 2.6% and late intervention rate was 3.1%. In the untreated 2+ AR group, on last follow-up echocardiogram, 58% had improvement in AR, 41% remained 2+, and only 1% progressed to severe AR., Conclusions: Aortic valve surgery in select patients with concomitant moderate AR can be added with minimal added risk, but untreated AR does not influence long-term survival after cardiac surgery and rarely required late intervention., (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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25. A Practical Approach to Left Main Coronary Artery Disease: JACC State-of-the-Art Review.
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Davidson LJ, Cleveland JC, Welt FG, Anwaruddin S, Bonow RO, Firstenberg MS, Gaudino MF, Gersh BJ, Grubb KJ, Kirtane AJ, Tamis-Holland JE, Truesdell AG, Windecker S, Taha RA, and Malaisrie SC
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- Humans, Coronary Artery Bypass, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Practice Guidelines as Topic, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Percutaneous Coronary Intervention
- Abstract
The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Recent clinical practice guidelines provide clinicians with guidance; however, decisions regarding treatment for individual patients can still be difficult. The American College of Cardiology's Cardiac Surgery Team and Interventional Council joined together to develop a practical approach to the treatment of LM CAD, taking into account randomized clinical trial, meta-analyses, and clinical practice guidelines. The various presentations of LM CAD based on anatomy and physiology are presented. Recognizing the complexity of LM CAD, which rarely presents isolated and is often in combination with multivessel disease, a treatment algorithm with medical therapy alone or in conjunction with percutaneous coronary intervention or coronary artery bypass grafting is proposed. A heart team approach is recommended that accounts for clinical, procedural, operator, and institutional factors, and features shared decision-making that meets the needs and preferences of each patient and their specific clinical situation., Competing Interests: Funding Support and Author Disclosures Dr Davidson is a co-investigator for Edwards Lifesciences and Abbott clinical trials. Dr Cleveland has received research grants from Medtronic and Abbott; has served on research committees for Abbott; has been a consultant for and received honoraria from ConneX Biomedical and Medtronic; and has received honoraria from Edwards Lifesciences. Dr Welt has been a consultant for and received honoraria from Medtronic; and holds stock in Xenter, Inc. Dr Anwaruddin has been a consultant and proctor for Edwards Lifesciences and Medtronic; has served on a steering committee for Boston Scientific; and holds equity in East End Medical. Dr Grubb has been a speaker for Edwards Lifesciences, Boston Scientific, and Medtronic; has been a proctor for Edwards Lifesciences and Medtronic; has served on advisory boards for Medtronic and Abbott; has been a principal investigator for trials sponsored by Edwards Lifesciences and Medtronic; and has been a consultant for Gore. Dr Kirtane has been a consultant for IMDS; has received travel expenses/meals from Medtronic, Boston Scientific, Abbott Vascular, CSI, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron; and has received research grants from, been a consultant for, an/or received speaker fees from Medtronic, Boston Scientific, Abbott Vascular, Amgen, CSI, Philips, ReCor Medical, Neurotronic, Biotronik, Chiesi, Bolt Medical, Magenta Medical, Canon, and SoniVie, paid to his institution. Dr Truesdell has received consultant and speaker fees, paid to his institution, from Abiomed Inc. Dr Windecker has received research and educational grants paid to employer from Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Corflow Therapeutics, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Janssen-Cilag, Johnson & Johnson, Medicure, Medtronic, Merck Sharp & Dohm, Miracor Medical, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pfizer, Polares, Regeneron, Sanofi, Servier, Sinomed, Terumo, Vifor, V-Wave; has served as advisory board member and/or member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, Janssen, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, V-Wave, and Xeltis with payments to employer but no personal payments; and has been a member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. Dr Malaisrie has been a consultant for and received research funding from Edwards Lifesciences, Medtronic, Terumo Aortic, and Artivion. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022. Published by Elsevier Inc.)
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- 2022
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26. Left Ventricular Volume and Outcomes in Patients With Chronic Aortic Regurgitation.
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Bonow RO and O'Gara PT
- Subjects
- Heart Ventricles diagnostic imaging, Humans, Stroke Volume, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery
- Published
- 2022
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27. The need for comprehensive multidisciplinary programs, complex interventions, and precision medicine for bicuspid aortic valve disease.
- Author
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Crawford EE, McCarthy PM, Malaisrie SC, Mehta CK, Puthumana JJ, Robinson JD, Markl M, Bonow RO, and Fedak PWM
- Abstract
Patients with bicuspid aortic valves commonly require an intervention on their valve and/or aorta. Because of their heterogeneous presentations, recommendations for imaging surveillance and surgery timing are highly individualized. Critical points in care include time of diagnosis, transition from adolescent to adult medicine, and surgery referral. To better support patients with bicuspid aortic valves, we developed a comprehensive program that utilizes the multidisciplinary care team, complex interventions, and translational research protocols. We describe our program structure and experience with this common and sometimes challenging diagnosis., Competing Interests: Conflicts of Interest: PMM: Royalties: Edwards Lifesciences, Inc.; Speaker fees: Atricure, Inc.; Medtronic, Inc.; Edwards Lifesciences, Inc. SCM: Consultant: Edwards Lifesciences, Inc., Medtronic, Inc.; Cryolife; Terumo Aortic. MM: Research support: Siemens; Grant: Circle Cardiovascular Imaging ROB: Editor-in-Chief, JAMA Cardiology. PWMF: Consultant: Aziyo Biologics Inc., Abyrx Inc. The other authors have no conflicts of interest to declare., (2022 Annals of Cardiothoracic Surgery. All rights reserved.)
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- 2022
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28. Communicating the Benefits of Vaccination in Light of Potential Risks.
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Navar AM and Bonow RO
- Subjects
- Humans, Communication, Vaccination
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- 2022
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29. Association of Regional Wall Shear Stress and Progressive Ascending Aorta Dilation in Bicuspid Aortic Valve.
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Soulat G, Scott MB, Allen BD, Avery R, Bonow RO, Malaisrie SC, McCarthy P, Fedak PWM, Barker AJ, and Markl M
- Subjects
- Adult, Aorta diagnostic imaging, Aortic Valve diagnostic imaging, Blood Flow Velocity, Dilatation, Hemodynamics, Humans, Middle Aged, Predictive Value of Tests, Retrospective Studies, Stress, Mechanical, Bicuspid Aortic Valve Disease, Heart Valve Diseases
- Abstract
Objectives: The aim of this study was to evaluate the role of wall shear stress (WSS) as a predictor of ascending aorta (AAo) growth at 5 years or greater follow-up., Background: Aortic 4-dimensional flow cardiac magnetic resonance (CMR) can quantify regions exposed to high WSS, a known stimulus for arterial wall dysfunction. However, its association with longitudinal changes in aortic dilation in patients with bicuspid aortic valve (BAV) is unknown., Methods: This retrospective study identified 72 patients with BAV (age 45 ± 12 years) who underwent CMR for surveillance of aortic dilation at baseline and ≥5 years of follow-up. Four-dimensional flow CMR analysis included the calculation of WSS heat maps to compare regional WSS in individual patients with population averages of healthy age- and sex-matched subjects (database of 136 controls). The relative areas of the AAo and aorta (in %) exposed to elevated WSS (outside the 95% CI of healthy population averages) were quantified., Results: At a median follow-up duration of 6.0 years, the mean AAo growth rate was 0.24 ± 0.20 mm/y. The fraction of the AAo exposed to elevated WSS at baseline was increased for patients with higher growth rates (>0.24 mm/y, n = 32) compared with those with growth rates <0.24 mm/y (19.9% [IQR: 10.2%-25.5%] vs 5.7% [IQR: 1.5%-21.3%]; P = 0.008). Larger areas of elevated WSS in the AAo and entire aorta were associated with higher rates of AAo dilation >0.24 mm/y (odds ratio: 1.51; 95% CI: 1.05-2.17; P = 0.026 and odds ratio: 1.70; 95% CI: 1.01-3.15; P = 0.046, respectively)., Conclusions: The area of elevated AAo WSS as assessed by 4-dimensional flow CMR identified BAV patients with higher rates of aortic dilation and thus might determine which patients require closer follow-up., Competing Interests: Funding Support and Author Disclosures Funding was provided by National Institutes of Health (grant nos. R01HL115828, R01HL133504, and F30HL145995). Dr Soulat received a grant support from the French College of Radiology Teachers and French Radiology Society. Additional support was provided by the Melman Bicuspid Aortic Valve Program, Bluhm Cardiovascular Institute. Dr Malaisrie has received honoraria and a research grant from Terumo Aortic. Dr McCarthy has received royalties and honoraria for speaking for Edwards Lifesciences. Dr Markl has received research support from Siemens Healthineers; a research grant and consulting fees from Circle Cardiovascular Imaging; and a research grant from Cryolife Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2022
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30. Overview of trials from AHA 2021.
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Gergis M, Nagy S, and Bonow RO
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- 2021
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31. Direct mitral regurgitation quantification in hypertrophic cardiomyopathy using 4D flow CMR jet tracking: evaluation in comparison to conventional CMR.
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Gupta AN, Avery R, Soulat G, Allen BD, Collins JD, Choudhury L, Bonow RO, Carr J, Markl M, and Elbaz MSM
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- Humans, Magnetic Resonance Imaging, Cine, Magnetic Resonance Spectroscopy, Observer Variation, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Cardiomyopathy, Hypertrophic diagnostic imaging, Mitral Valve Insufficiency diagnostic imaging
- Abstract
Background: Quantitative evaluation of mitral regurgitation (MR) in hypertrophic cardiomyopathy (HCM) by cardiovascular magnetic resonance (CMR) relies on an indirect volumetric calculation. The aim of this study was to directly assess and quantify MR jets in patients with HCM using 4D flow CMR jet tracking in comparison to standard-of-care CMR indirect volumetric method., Methods: This retrospective study included patients with HCM undergoing 4D flow CMR. By the indirect volumetric method from CMR, MR volume was quantified as left ventricular stroke volume minus forward aortic volume. By 4D flow CMR direct jet tracking, multiplanar reformatted planes were positioned in the peak velocity of the MR jet during systole to calculate through-plane regurgitant flow. MR severity was collected for agreement analysis from a clinical echocardiograms performed within 1 month of CMR. Inter-method and inter-observer agreement were assessed by intraclass correlation coefficient (ICC), Bland-Altman analysis, and Cohen's kappa., Results: Thirty-seven patients with HCM were included. Direct jet tracking demonstrated good inter-method agreement of MR volume compared to the indirect volumetric method (ICC = 0.80, p = 0.004) and fair agreement of MR severity (kappa = 0.27, p = 0.03). Direct jet tracking showed higher agreement with echocardiography (kappa = 0.35, p = 0.04) than indirect volumetric method (kappa = 0.16, p = 0.35). Inter-observer reproducibility of indirect volumetric method components revealed the lowest reproducibility in end-systolic volume (ICC = 0.69, p = 0.15). Indirect volumetric method showed good agreement of MR volume (ICC = 0.80, p = 0.003) and fair agreement of MR severity (kappa = 0.38, p < 0.001). Direct jet tracking demonstrated (1) excellent inter-observer reproducibility of MR volume (ICC = 0.97, p < 0.001) and MR severity (kappa = 0.84, p < 0.001) and (2) excellent intra-observer reproducibility of MR volume (ICC = 0.98, p < 0.001) and MR severity (kappa = 0.88, p < 0.001)., Conclusions: Quantifying MR and assessing MR severity by indirect volumetric method in HCM patients has limited inter-observer reproducibility. 4D flow CMR jet tracking is a potential alternative technique to directly quantify and assess MR severity with excellent inter- and intra-observer reproducibility and higher agreement with echocardiography in this population., (© 2021. The Author(s).)
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- 2021
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32. Fibrosis in Hypertrophic Cardiomyopathy Patients With and Without Sarcomere Gene Mutations.
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Vullaganti S, Levine J, Raiker N, Syed AA, Collins JD, Carr JC, Bonow RO, and Choudhury L
- Subjects
- Contrast Media, Fibrosis, Gadolinium, Humans, Magnetic Resonance Imaging, Cine, Mutation, Myocardium pathology, Cardiomyopathy, Hypertrophic diagnosis, Cardiomyopathy, Hypertrophic diagnostic imaging, Sarcomeres genetics
- Abstract
Background: Patients with hypertrophic cardiomyopathy (HCM) and an identified sarcomere mutation have worse outcomes than those without though the underlying mechanism is incompletely understood. The presence of replacement fibrosis measured by late gadolinium enhancement (LGE) and diffuse fibrosis measured by extracellular volume (ECV) using cardiac magnetic resonance imaging (CMR) are associated with ventricular arrhythmias and cardiac mortality. We aimed to associate these two forms of fibrosis with identified sarcomere mutations., Methods and Results: Three hundred and thirty-six (336) patients with HCM underwent CMR at a single quaternary referral centre between January 2012 and February 2017. Genetic testing was performed in 73 of these patients, yielding an identified sarcomeric mutation in 29 (G+), no mutation in 39 (G-), and a variant of unknown significance (VUS) in five. LGE was more prevalent in G+ compared to G- patients (86 vs. 56%, OR 4.3, p=0.01) and was more extensive (7.5±5.5% of left ventricular [LV] mass vs. 3.0±3.0%, p<0.001). Global ECV from myocardial segments excluding LGE was similar among both groups (26.9±2.9 vs. 25.6±2.8%, p=0.46). However, in G+ patients ECV was greater in the hypertrophied regions of the basal anteroseptum (30.2±7.0 vs. 26.8±3.6%, p=0.004) and basal inferoseptum (28.1±4.3 vs. 26.2±2.9%, p=0.005)., Conclusions: Genotyped HCM patients with an identified sarcomere mutation have greater LGE and greater regional, but not global, ECV than HCM patients without an identified mutation. This difference in fibrosis may contribute to worse outcomes in patients with an identified HCM mutation., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2021
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33. Temporal Associations Between Immunization With the COVID-19 mRNA Vaccines and Myocarditis: The Vaccine Safety Surveillance System Is Working.
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Navar AM, McNally E, Yancy CW, O'Gara PT, and Bonow RO
- Subjects
- COVID-19 Vaccines, Humans, Immunization, RNA, Messenger, SARS-CoV-2, COVID-19, Myocarditis, Vaccines adverse effects
- Published
- 2021
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34. Myocardial Viability Assessment Before Surgical Revascularization in Ischemic Cardiomyopathy: JACC Review Topic of the Week.
- Author
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Panza JA, Chrzanowski L, and Bonow RO
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- Cardiomyopathies surgery, Humans, Myocardial Ischemia surgery, Ventricular Function, Left, Cardiomyopathies physiopathology, Myocardial Ischemia physiopathology, Myocardial Revascularization, Myocardium, Tissue Survival
- Abstract
Ischemic cardiomyopathy results from the combination of scar with fibrosis replacement and areas of dysfunctional but viable myocardium that may improve contractile function with revascularization. Observational studies reported that only patients with substantial amounts of myocardial viability had better outcomes following surgical revascularization. Accordingly, dedicated noninvasive techniques have evolved to quantify viable myocardium with the objective of selecting patients for this form of therapeutic intervention. However, prospective trials have not confirmed the interaction between myocardial viability and the treatment effect of revascularization. Furthermore, recent observations indicate that recovery of left ventricular function is not the principal mechanism by which surgical revascularization improves prognosis. In this paper, the authors describe a more contemporary application of viability testing that is founded on the alternative concept that the main goal of surgical revascularization is to prevent further damage by protecting the residual viable myocardium from subsequent acute coronary events., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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35. 4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction.
- Author
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Gupta AN, Soulat G, Avery R, Allen BD, Collins JD, Choudhury L, Bonow RO, Carr J, Markl M, and Elbaz MSM
- Subjects
- Female, Humans, Magnetic Resonance Imaging, Predictive Value of Tests, Retrospective Studies, Cardiomyopathy, Hypertrophic complications, Cardiomyopathy, Hypertrophic diagnostic imaging, Mitral Valve Insufficiency diagnostic imaging, Ventricular Outflow Obstruction diagnostic imaging, Ventricular Outflow Obstruction etiology
- Abstract
To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆P
MRI ) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KELA ) was computed throughout systole. Average systolic (KELA-avg ) and peak systolic (KELA-peak ) KELA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆PMRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KELA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KELA-avg (14.8 [10.6, 20.4] J/m3 vs. 33.4 [23.9, 61.3] J/m3 , P < 0.001) and KELA-peak (22.1 [15.9, 28.7] J/m3 vs. 57.2 [44.5, 121.4] J/m3 , P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KELA-avg (rho = 0.81, P < 0.001) and KELA-peak (rho = 0.79, P < 0.001). LVOT ∆PMRI was strongly correlated with KELA metrics in obstructive HCM (KELA-avg : rho = 0.86, P < 0.001; KELA-peak : rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.)- Published
- 2021
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36. Equity and the JAMA Network.
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Fontanarosa PB, Flanagin A, Ayanian JZ, Bonow RO, Bressler NM, Christakis D, Disis ML, Josephson SA, Kibbe MR, Öngür D, Piccirillo JF, Redberg RF, Rivara FP, Shinkai K, and Yancy CW
- Subjects
- Cultural Diversity, United States, American Medical Association, Editorial Policies, Periodicals as Topic standards, Racism
- Published
- 2021
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37. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
- Author
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Deswal A, Dixon DL, Fleisher LA, de las Fuentes L, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Spatz ES, Tamis-Holland J, Wijeysundera DN, and Woo YJ
- Subjects
- Consensus, Evidence-Based Medicine standards, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Heart Valve Prosthesis standards, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Heart Valves diagnostic imaging, Heart Valves physiopathology, Hemodynamics, Humans, Prosthesis Design, Recovery of Function, Risk Factors, Treatment Outcome, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation standards, Heart Valves surgery
- Published
- 2021
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38. Improving Terminology to Describe Coronary Artery Procedures: JACC Review Topic of the Week.
- Author
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Doenst T, Bonow RO, Bhatt DL, Falk V, and Gaudino M
- Subjects
- Coronary Artery Disease complications, Humans, Myocardial Ischemia etiology, Coronary Artery Bypass, Coronary Artery Disease surgery, Myocardial Ischemia prevention & control, Percutaneous Coronary Intervention, Terminology as Topic
- Abstract
Coronary artery disease (CAD) is treated with medical therapy with or without percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The latter 2 options are commonly referred to as "myocardial revascularization" procedures. We reason that this term is inappropriate because it is suggestive of a single treatment effect of PCI and CABG (ie, the reestablishment of blood flow to ischemic myocardium) and obscures key mechanisms, such as the improvement in coronary flow capability in the absence of ongoing ischemia, the reperfusion in the presence of ischemia, and the prevention of myocardial infarction from CAD progression. We review the current evidence on the topic and suggest the use of a purely descriptive terminology ("invasive treatment by PCI or CABG") which has the potential to improve clinical decision making and guide future trial design., Competing Interests: Funding Support and Author Disclosures Dr. Bhatt has served on the Advisory Board for Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, MyoKardia, PhaseBio, PLx Pharma, and Regado Biosciences; has served on the Board of Directors for Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; has served as Chair for the American Heart Association Quality Oversight Committee; has served on the Data Monitoring Committees for the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi- Sankyo), Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, MyoKardia, Owkin, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi, Synaptic, The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has been a site co-investigator for Biotronik, Boston Scientific, CSI, St Jude Medical (now Abbott), and Svelte; has been a trustee for theAmerican College of Cardiology; has performed unfunded researchfor FlowCo, Merck, Novo Nordisk, andTakeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2021
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39. Failed Mitral TEER: Are There Lessons for Decision Making?
- Author
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Verma S, Latter DA, and Bonow RO
- Subjects
- Decision Making, Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Mitral Valve Insufficiency surgery
- Abstract
Competing Interests: Funding Support and Author Disclosures All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Published
- 2021
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40. Resurgence of the Ross procedure.
- Author
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Bonow RO
- Abstract
Competing Interests: Conflicts of Interest: No relationships to disclosed other than Editor in Chief, JAMA Cardiology.
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- 2021
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41. Extracellular Volume in Primary Mitral Regurgitation.
- Author
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Kitkungvan D, Yang EY, El Tallawi KC, Nagueh SF, Nabi F, Khan MA, Nguyen DT, Graviss EA, Lawrie GM, Zoghbi WA, Bonow RO, Quinones MA, and Shah DJ
- Subjects
- Humans, Predictive Value of Tests, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery
- Abstract
Objectives: This study used cardiovascular magnetic resonance (CMR) to evaluate whether elevated extracellular volume (ECV) was associated with mitral valve prolapse (MVP) or if elevated ECV was a consequence of remodeling independent of primary mitral regurgitation (MR) etiology., Background: Replacement fibrosis in primary MR is more prevalent in MVP; however, data on ECV as a surrogate for diffuse interstitial fibrosis in primary MR are limited., Methods: Patients with chronic primary MR underwent comprehensive CMR phenotyping and were stratified into an MVP cohort (>2 mm leaflet displacement on a 3-chamber cine CMR) and a non-MVP cohort. Factors associated with ECV and replacement fibrosis were assessed. The association of ECV and symptoms related to MR and clinical events (mitral surgery and cardiovascular death) was ascertained., Results: A total of 424 patients with primary MR (229 with MVP and 195 non-MVP) were enrolled. Replacement fibrosis was more prevalent in the MVP cohort (34.1% vs. 6.7%; p < 0.001), with bi-leaflet MVP having the strongest association with replacement fibrosis (odds ratio: 10.5; p < 0.001). ECV increased with MR severity in a similar fashion for both MVP and non-MVP cohorts and was associated with MR severity but not MVP on multivariable analysis. Elevated ECV was independently associated with symptoms related to MR and clinical events., Conclusions: Although replacement fibrosis was more prevalent in MVP, diffuse interstitial fibrosis as inferred by ECV was associated with MR severity, regardless of primary MR etiology. ECV was independently associated with symptoms related to MR and clinical events. (DeBakey Cardiovascular Magnetic Resonance Study [DEBAKEY-CMR]; NCT04281823)., Competing Interests: Funding Support And Author Disclosures Dr. Shah has received support from the National Science Foundation (CNS-1931884) and the Beverly B. and Daniel C. Arnold Distinguished Centennial Chair Endowment. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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42. JAMA Cardiology-The Year in Review, 2020.
- Author
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Bonow RO
- Subjects
- Cardiology, Humans, Bibliometrics, Journal Impact Factor, Periodicals as Topic
- Published
- 2021
- Full Text
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43. Reconsidering the Ross Procedure.
- Author
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Bonow RO and O'Gara PT
- Subjects
- Humans, Aortic Valve surgery, Heart Valve Prosthesis Implantation
- Published
- 2021
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44. Four-Dimensional Magnetic Resonance After Ross Procedure for Unicuspid Aortic Valve.
- Author
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Drullinsky D, Mehta CK, Scott MB, Crawford E, Markl M, Bonow RO, Mendelson MA, El-Hamamsy I, and Malaisrie SC
- Subjects
- Aortic Valve surgery, Heart Valve Diseases surgery, Humans, Male, Middle Aged, Severity of Illness Index, Aortic Valve diagnostic imaging, Heart Valve Diseases diagnosis, Heart Valve Prosthesis Implantation methods, Image Processing, Computer-Assisted methods, Magnetic Resonance Imaging, Cine methods
- Published
- 2021
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45. Asymptomatic degenerative mitral regurgitation repair: Validating guidelines for early intervention.
- Author
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Desai A, Thomas JD, Bonow RO, Kruse J, Andrei AC, Cox JL, and McCarthy PM
- Subjects
- Aged, Asymptomatic Diseases, Clinical Decision-Making, Databases, Factual, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation mortality, Hemodynamics, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency physiopathology, Recurrence, Reoperation, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Heart Valve Prosthesis Implantation standards, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Practice Guidelines as Topic standards
- Abstract
Introduction: Mitral repair for asymptomatic (New York Heart Association [NYHA] class I) degenerative mitral regurgitation (MR) is supported by the guidelines, but is not performed often. We sought to determine outcomes for asymptomatic patients when compared with those with symptoms., Methods: Between 2004 and 2018, 1027 patients underwent mitral replacement (22) or repair with or without other cardiac surgery (1005), the latter being grouped by NYHA class: I (n = 470; 47%), II (n = 408; 40%), or III/IV (n = 127; 13%). Statistical analyses included propensity score matching and weighting, and multistate models., Results: The proportion of patients designated as NYHA class I undergoing surgery increased steadily during this period (P < .001). Overall, 30-day mortality was 0.4%, and zero for patients designated NYHA class I. Unadjusted 10-year survival was significantly greater in patients designated NYHA class I compared with II and III/IV (P < .001). Freedom from reoperation at 10 years was 99.8% overall, and 100% for patients designated NYHA class I. In patients designated as NYHA class I, predischarge and 10-year moderate MR were 0.7% and 20.1%, whereas more than moderate was zero and 0.6%. Preoperative ejection fraction less than 60% was associated with late mortality (P = .025). After covariate-adjustments, freedom from MR and tricuspid regurgitation were not statistically significantly different by NYHA class. However, overall survival was significantly worse in patients with NYHA class III/IV, compared with class II., Conclusions: Mitral repair in asymptomatic patients is safe and durable. Careful monitoring until class II symptoms is appropriate. However, repair before ejection fraction decreases below 60% is important for late overall survival., (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2021
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46. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
- Author
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, and Toly C
- Abstract
Aim: This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use., Methods: A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline., Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines., (Copyright © 2021 American College of Cardiology Foundation and the American Heart Association, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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47. Left Ventricular End-Systolic Volume in Chronic Aortic Regurgitation-Finally, a Step Forward.
- Author
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Bonow RO and O'Gara PT
- Subjects
- Aorta, Humans, Stroke Volume, Systole, Ventricular Function, Left, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery
- Published
- 2021
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48. Targeting cardiovascular inflammation: next steps in clinical translation.
- Author
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Lawler PR, Bhatt DL, Godoy LC, Lüscher TF, Bonow RO, Verma S, and Ridker PM
- Subjects
- Biomarkers, C-Reactive Protein analysis, Humans, Inflammation, Acute Coronary Syndrome drug therapy, Atherosclerosis, Cardiovascular Diseases prevention & control, Myocardial Infarction
- Abstract
Systemic vascular inflammation plays multiple maladaptive roles which contribute to the progression and destabilization of atherosclerotic cardiovascular disease (ASCVD). These roles include: (i) driving atheroprogression in the clinically stable phase of disease; (ii) inciting atheroma destabilization and precipitating acute coronary syndromes (ACS); and (iii) responding to cardiomyocyte necrosis in myocardial infarction (MI). Despite an evolving understanding of these biologic processes, successful clinical translation into effective therapies has proven challenging. Realizing the promise of targeting inflammation in the prevention and treatment of ASCVD will likely require more individualized approaches, as the degree of inflammation differs among cardiovascular patients. A large body of evidence has accumulated supporting the use of high-sensitivity C-reactive protein (hsCRP) as a clinical measure of inflammation. Appreciating the mechanistic diversity of ACS triggers and the kinetics of hsCRP in MI may resolve purported inconsistencies from prior observational studies. Future clinical trial designs incorporating hsCRP may hold promise to enable individualized approaches. The aim of this Clinical Review is to summarize the current understanding of how inflammation contributes to ASCVD progression, destabilization, and adverse clinical outcomes. We offer forward-looking perspective on what next steps may enable successful clinical translation into effective therapeutic approaches-enabling targeting the right patients with the right therapy at the right time-on the road to more individualized ASCVD care., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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49. Cardiovascular Magnetic Resonance in Right Heart and Pulmonary Circulation Disorders.
- Author
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Contaldi C, Capuano F, Romano L, Ranieri B, Ferrara F, Mirto G, Rega S, Cocchia R, Stanziola AA, Ostenfeld E, Dellegrottaglie S, Bossone E, and Bonow RO
- Subjects
- Cardiomyopathies etiology, Cardiomyopathies physiopathology, Humans, Hypertension, Pulmonary complications, Hypertension, Pulmonary physiopathology, Magnetic Resonance Spectroscopy, Cardiomyopathies diagnosis, Hypertension, Pulmonary diagnosis, Magnetic Resonance Imaging, Cine methods, Pulmonary Circulation physiology, Ventricular Function, Right physiology
- Abstract
Right heart and pulmonary circulation disorders are generally caused by right ventricle (RV) pressure overload, volume overload, and cardiomyopathy, and they are associated with distinct clinical courses and therapeutic approaches, although they often may coexist. Cardiac magnetic resonance (CMR) provides a noninvasive accurate and reproducible multiplanar anatomic and functional assessment, tissue characterization, and blood flow evaluation of the right heart and pulmonary circulation. This article reviews the current status of the CMR, the most recent techniques, the new parameters and their clinical utility in diagnosis, prognosis, and therapeutic management in the right heart and pulmonary circulation disorders., Competing Interests: Disclosure Funding: This research did not receive any specific grant from funding agencies in the public, commercial, ornot-for-profit sectors., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
50. Explanation for the Corrections for the Study of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019.
- Author
-
Bonow RO and Yancy CW
- Subjects
- Betacoronavirus, COVID-19, Humans, Magnetic Resonance Imaging, SARS-CoV-2, Coronavirus, Coronavirus Infections, Pandemics, Pneumonia, Viral
- Published
- 2020
- Full Text
- View/download PDF
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