Search

Your search keyword '"Roldan, Paola C."' showing total 12 results
Start Over Author "Roldan, Paola C." Publication Year Range Last 10 years
12 results on '"Roldan, Paola C."'

2. Lambl's Excrescences: Association with Cerebrovascular Disease and Pathogenesis

Author

Roldan, Carlos A, Schevchuck, Oleksandr, Tolstrup, Kirsten, Roldan, Paola C, Macias, Leonardo, Qualls, Clifford R, Greene, Ernest R, Hayek, Reyaad, Charlton, Gerald A, and Sibbitt, Wilmer L

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Atherosclerosis, Clinical Research, Brain Disorders, Heart Disease, Aging, Stroke, Cardiovascular, Neurosciences, Lupus, Adolescent, Adult, Cerebrovascular Disorders, Cross-Sectional Studies, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Female, Heart Valve Diseases, Heart Valves, Humans, Incidence, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Predictive Value of Tests, Prevalence, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Time Factors, Ultrasonography, Doppler, Transcranial, Young Adult, Lambl's excrescences, Cerebrovascular disease, Magnetic resonance imaging, Transcranial Doppler, Transesophageal echocardiography, Neurology & Neurosurgery, Clinical sciences
Abstract

BackgroundLambl's excrescences (LEx) are detected by transesophageal echocardiography (TEE) and are characterized as thin, elongated, and hypermobile structures located at the leaflets' coaptation point of the heart valves. The association of LEx with cerebrovascular disease (CVD) is still undefined and yet patients with LEx and suspected CVD receive unproven effective antiplatelet or anticoagulant therapy or even undergo valve surgery. Also, the association of LEx with aging and atherogenic, inflammatory, or thrombogenic parameters has not been reported.MethodsSeventy-seven patients with systemic lupus erythematosus (SLE) (71 women, age 37 ± 12 years) and 26 age- and sex-matched healthy controls (22 women, age 34 ± 11 years) prospectively underwent routine history and physical exam, transcranial Doppler, brain MRI, TEE, carotid duplex, and clinical and laboratory evaluations of atherogenesis, inflammation, platelet activity, coagulation, and fibrinolysis. Subjects without stroke/TIA on enrollment (with and without LEx) had a median follow-up of 57 months.ResultsOn enrollment, 33 (43%) of 77 patients had CVD manifested as acute stroke/TIA (23 patients), cerebromicroembolism by transcranial Doppler (17 patients), or cerebral infarcts by MRI (14 patients). Mitral or aortic valve LEx were equally frequent in healthy controls (46%) as in patients with and without any CVD (39 and 43%), stroke/TIA (35 and 43%), cerebromicroembolism (41 and 42%), or cerebral infarcts (36 and 43%) (all p ≥ 0.72). Also, other mechanisms for CVD other than LEx such as Libman-Sacks vegetations, patent foramen ovale or interatrial septal aneurysm, aortic or carotid atherosclerosis, or thrombogenesis were found in ≥94% of patients with CVD. In addition, 36 subjects with and 44 without LEx had similar low incidence of stroke/TIA (1 (1.3%) and 2 (2.5%), respectively, p = 1.0) during follow-up. Finally, LEx were not associated with aging, atherogenic risk factors, atherosclerosis, inflammation, or thrombogenesis.ConclusionsIn this study, LEx are similarly prevalent in healthy controls and SLE patients, are not associated with CVD, and are not associated with pathogenic risk factors. Therefore, the study findings suggest that LEx may not be cardioembolic substrates, may not represent pathologic valve structures, and may not require therapy.

Published
2015

12. Abstract 14197: Variability in Healthcare Utilization by Adults With Congenital Heart Disease in Oregon

Author

McGrath, Lidija B, Ramsey, Katrina, Roldan, Paola C, Broberg, Craig S, and Khan, Abigail

Abstract

Introduction:Despite improved outcomes when adults with congenital heart disease (ACHD) are cared for at specialized centers, these centers serve only a minority of patients. It has been suggested that rural patients may be less likely to attend care at ACHD centers than urban dwelling patients, contributing to disparities in care and outcomes. The goal of this study was to determine if healthcare utilization differs between rural and non-rural ACHD patients in Oregon.Methods:The Oregon All Payer All Claims (APAC) database for the years 2010-2012 was queried for adults 18 to 65 years of age with ICD-9 codes for congenital heart disease (CHD). A validated hierarchical algorithm was applied to classify diagnoses in the study cohort, excluding non-specific CHD and Marfan syndrome. Additional utilization variables were created by standard methods. Probabilities of utilization were estimated by mean predictions from logistic regression with age as a covariate.Results:A total of 5055 patients with CHD were identified; mean (SD) age was 43 (15) years. 2525 patients (50%) lived in the Portland metropolitan area, 1526 (30%) in other metropolitan areas of Oregon, and 1004 (20%) in rural areas. Rural-dwelling patients were more likely to receive Medicaid (42% vs 25%, p<0.001), and, after age adjustment, more likely to visit the emergency room (32% vs. 25%, p<0.001) and their primary care provider (78% vs 73%, p=0.004), but not cardiology providers of any type (p=0.4). In spite of distance, patients accessed specialized ACHD care about equally across regions (14% in the Portland area vs 16% in rural areas).Conclusions:ACHD patients in rural areas are high utilizers of emergency and primary care, but are not more likely to receive either specialized ACHD or general cardiology care. Initiatives to facilitate care coordination between local providers and specialized centers may improve the efficacy and outcome of care for rural dwelling individuals with ACHD.

Published
2019
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results