116 results on '"Athena Poppas"'
Search Results
2. The Tobacco Endgame
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Athena Poppas, Fausto J. Pinto, Stephan Achenbach, Jeffrey Willett, and Mitchell S.V. Elkind
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business.industry ,Law ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Chess endgame - Published
- 2021
3. Clinician Well-Being—addressing global needs for improvements in the health care field: a joint opinion from the American College of Cardiology, American Heart Association, European Society of Cardiology, World Heart Federation
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Fausto J. Pinto, Stephan Achenbach, Athena Poppas, Laxmi S. Mehta, and Mitchell S.V. Elkind
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medicine.medical_specialty ,burnout ,business.industry ,Cardiology ,resiliency ,Heart ,American Heart Association ,practice efficiency ,United States ,Special Article ,professional fulfillment ,well-being ,Family medicine ,Health care ,Well-being ,medicine ,Humans ,AcademicSubjects/MED00200 ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Societies, Medical - Published
- 2021
4. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report
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Ileana L. Piña, Richard E. Anderson, Lynn Todman, Laxmi S. Mehta, Daniel J. Murphy, Frederick A. Masoudi, Willie Lawrence, Pamela S. Douglas, Rita F. Redberg, Sharonne N. Hayes, Keith C. Ferdinand, Camara Phyllis Jones, Glenn N. Levine, Megan Coylewright, Michael J. Mack, John A. Spertus, Jennifer E. Miller, Gaby Weissman, Katherine A. Sheehan, Adrian F. Hernandez, Bernadette M. Broccolo, John P. Erwin, Jennifer H. Mieres, William J. Oetgen, Colin P. West, Cathleen Biga, Emelia J. Benjamin, Jorge F. Saucedo, Clyde W. Yancy, Robert A. Harrington, Daniel D. Matlock, Karen L. Furie, Mark A. Creager, Ivor J. Benjamin, Richard A. Chazal, Edward T.A. Fry, C. Michael Valentine, William H. Roach, Athena Poppas, and Ralph G. Brindis
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Research Report ,Consensus ,Association (object-oriented programming) ,media_common.quotation_subject ,Advisory Committees ,Cardiology ,Racism ,Documentation ,Physiology (medical) ,Cultural diversity ,Humans ,Medicine ,Ethics, Medical ,Quality of Health Care ,media_common ,Medical education ,Maryland ,business.industry ,Conflict of interest ,Consensus conference ,American Heart Association ,Social justice ,United States ,Health equity ,Professionalism ,Cardiovascular Diseases ,business ,Cardiology and Cardiovascular Medicine - Published
- 2021
5. Eosinophilic Myocarditis in a Patient With Sickle Cell Disease
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Athena Poppas, Ned H. Gutman, Michael K. Atalay, Hafiz Imran, and Kashif Ather
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,Myocarditis ,left ventricle ,medicine.medical_treatment ,Splenectomy ,030105 genetics & heredity ,Chest pain ,cardiac magnetic resonance ,necrosis ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Prednisone ,medicine ,Eosinophilia ,Mini-Focus Issue: Imaging ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Transplantation ,cardiovascular system ,Case Report: Clinical Case ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,MRI, magnetic resonance imaging ,030217 neurology & neurosurgery ,medicine.drug - Abstract
A 23-year-old man with sickle cell disease treated with splenectomy and allogenic stem cell transplantation presented with recurrent chest pain, elevated cardiac enzymes, and unremarkable electrocardiography. His work-up revealed eosinophilia, raising concern for eosinophilic myocarditis. Cardiac magnetic resonance imaging showed patchy late gadolinium enhancement of the left ventricular free wall, suggestive of myocarditis. He was treated with high-dose intravenous steroids followed by oral prednisone, with improvement in his symptoms and eosinophilia and a decrease in cardiac enhancement on follow-up imaging. (Level of Difficulty: Intermediate.), Central Illustration
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- 2021
6. COVID-19 and the Athlete
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Athena Poppas, Richard J. Kovacs, and Eugene H. Chung
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Sports medicine ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Data science ,Return to sport ,Pandemic ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Mass screening - Published
- 2021
7. Mitral Valve Blood Cyst Diagnosed with the Use of Multimodality Imaging
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Michael K. Atalay, James G. Fingleton, Charles Beale, Athena Poppas, William A. Levin, Ronald Russo, Eirini Apostolidou, and Robert Beale
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Residual Ramifications ,medicine.anatomical_structure ,Cardiac magnetic resonance imaging ,Mitral valve blood cyst ,Echocardiography ,Mitral valve ,medicine ,Cyst ,Radiology ,business ,ComputingMethodologies_COMPUTERGRAPHICS - Abstract
Graphical abstract, Highlights • Intracardiac blood cyst is a rare congenital abnormality that can be found in adults. • It is most commonly attached in the valves, particularly the mitral valve. • Echocardiography is the imaging modality of choice for the diagnosis of blood cyst. • Cardiac MRI contributes to the diagnosis, typically showing absence of cyst enhancement. • Conservative management is reasonable in the absence of effects on cardiac function.
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- 2021
8. Bioprosthetic Valve Thrombosis: Insights from Transcatheter and Surgical Implants
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Athena Poppas, Patrick T. O'Gara, George Dangas, Martin B. Leon, John D. Carroll, Wayne Batchelor, David R. Holmes, Vinod H. Thourani, Jonathon Leipsic, Paul A. Gurbel, Michael J. Mack, Samir R. Kapadia, Mauro Chiarito, and Raj Makkar
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Bioprosthetic valve ,medicine.medical_specialty ,Aortic valve replacement ,business.industry ,cardiovascular system ,medicine ,Surgical implants ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Thrombosis ,Surgery - Abstract
Although aortic valve replacement with implantation of a bioprosthesis has been widely performed for more than 50 years, appreciation of the development of bioprosthetic leaflet thrombosis has incr...
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- 2020
9. Diversity and Inclusion
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Pamela S. Douglas, Athena Poppas, Quinn Capers, and Michelle A. Albert
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Inclusion (disability rights) ,business.industry ,media_common.quotation_subject ,MEDLINE ,Cardiology ,Library science ,Cardiovascular care ,Cultural Diversity ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Excellence ,Cultural diversity ,Medicine ,Humans ,030212 general & internal medicine ,Health Workforce ,Leadership Page ,Cardiology and Cardiovascular Medicine ,business ,Diversity (politics) ,media_common - Abstract
[Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] Diversity drives excellence. Inclusion is central to the American College of Cardiology (ACC) and to our entire cardiovascular profession ([1][2]). We cannot achieve our mission to transform cardiovascular care and
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- 2020
10. Cerebrovascular Perfusion among Older Adults with and Without Cardiovascular Disease
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Bindal Makwana, Athena Poppas, Ronald A. Cohen, Ariana Tart‐Zelvin, Xiaomeng Xu, Denise M. Cote, John Gunstad, and Lawrence H. Sweet
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Male ,medicine.medical_specialty ,Context (language use) ,Disease ,Article ,030218 nuclear medicine & medical imaging ,White matter ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Cerebral perfusion pressure ,Aged ,medicine.diagnostic_test ,business.industry ,Brain ,Magnetic resonance imaging ,Middle Aged ,Neurovascular bundle ,medicine.disease ,Magnetic Resonance Imaging ,White Matter ,medicine.anatomical_structure ,Cardiovascular Diseases ,Echocardiography ,Cerebrovascular Circulation ,Heart failure ,Cardiology ,Female ,Spin Labels ,Neurology (clinical) ,business ,Perfusion ,030217 neurology & neurosurgery - Abstract
BACKGROUND AND PURPOSE: Cardiovascular disease (CVD) encompasses a range of disorders that affect health and functioning in older adults. While cognitive declines have been linked to both cardiovascular and cerebral blood perfusion, protective neurovascular mechanisms raise the question whether cerebrovascular perfusion differs as a function of cardiovascular health status. The present study examined whether cerebrovascular perfusion significantly differs between healthy older adults with and without diagnosed CVD. The study also examined whether previously documented sex differences in cerebral perfusion would be replicated. METHODS: Twenty CVD patients without significant heart failure and 39 healthy controls were recruited to undergo a comprehensive assessment including an interview, echocardiogram, and magnetic resonance imaging (MRI). Arterial spin labeling (ASL) was used to quantify cerebral blood perfusion. RESULTS: Both groups exhibited mean left ventricular ejection fractions that fell within normal limits. In line with previous research, women exhibited significantly higher cerebral perfusion than men. There were no significant group differences in whole brain cerebrovascular perfusion, regional perfusion, or white matter perfusion by patient status after accounting for sex and age. CONCLUSIONS: These findings suggest that the effects of mild CVD on cerebrovascular perfusion are minimal. Future studies are needed to investigate the mechanisms involved in maintaining cerebrovascular perfusion in the context of altered peripheral perfusion determine and to determine whether this finding extends to more acute or severe CVD.
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- 2020
11. ACC.21 Virtual
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Athena Poppas, Pamela B. Morris, and Douglas E. Drachman
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World Wide Web ,business.industry ,Virtual experience ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
12. Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction
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Kenneth E Wood, Kevin F. Kennedy, J. Dawn Abbott, Marwan Saad, Hafiz Imran, Ernie Shippey, Herbert D. Aronow, David W. Louis, and Athena Poppas
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Adult ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Databases, Factual ,medicine.medical_treatment ,Myocardial Infarction ,Internal medicine ,medicine ,ST segment ,Humans ,Myocardial infarction ,Hospital Mortality ,cardiovascular diseases ,Propensity Score ,Pandemics ,Aged ,Retrospective Studies ,Original Investigation ,Aged, 80 and over ,business.industry ,SARS-CoV-2 ,Case-control study ,Percutaneous coronary intervention ,COVID-19 ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Hospitalization ,Concomitant ,Case-Control Studies ,Propensity score matching ,ST Elevation Myocardial Infarction ,Female ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Importance: There has been limited research on patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19. Objective: To compare characteristics, treatment, and outcomes of patients with STEMI with vs without COVID-19 infection. Design, Setting, and Participants: Retrospective cohort study of consecutive adult patients admitted between January 2019 and December 2020 (end of follow-up in January 2021) with out-of-hospital or in-hospital STEMI at 509 US centers in the Vizient Clinical Database (N = 80â¯449). Exposures: Active COVID-19 infection present during the same encounter. Main Outcomes and Measures: The primary outcome was in-hospital mortality. Patients were propensity matched on the likelihood of COVID-19 diagnosis. In the main analysis, patients with COVID-19 were compared with those without COVID-19 during the previous calendar year. Results: The out-of-hospital STEMI group included 76â¯434 patients (551 with COVID-19 vs 2755 without COVID-19 after matching) from 370 centers (64.1% aged 51-74 years; 70.3% men). The in-hospital STEMI group included 4015 patients (252 with COVID-19 vs 756 without COVID-19 after matching) from 353 centers (58.3% aged 51-74 years; 60.7% men). In patients with out-of-hospital STEMI, there was no significant difference in the likelihood of undergoing primary percutaneous coronary intervention by COVID-19 status; patients with in-hospital STEMI and COVID-19 were significantly less likely to undergo invasive diagnostic or therapeutic coronary procedures than those without COVID-19. Among patients with out-of-hospital STEMI and COVID-19 vs out-of-hospital STEMI without COVID-19, the rates of in-hospital mortality were 15.2% vs 11.2% (absolute difference, 4.1% [95% CI, 1.1%-7.0%]; P = .007). Among patients with in-hospital STEMI and COVID-19 vs in-hospital STEMI without COVID-19, the rates of in-hospital mortality were 78.5% vs 46.1% (absolute difference, 32.4% [95% CI, 29.0%-35.9%]; P < .001). Conclusions and Relevance: Among patients with out-of-hospital or in-hospital STEMI, a concomitant diagnosis of COVID-19 was significantly associated with higher rates of in-hospital mortality compared with patients without a diagnosis of COVID-19 from the past year. Further research is required to understand the potential mechanisms underlying this association.
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- 2021
13. Optimizing Clinical Practice Guidelines
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Mitchell S.V. Elkind, Athena Poppas, Patrick T. O'Gara, and Joshua A. Beckman
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business.industry ,Psychological intervention ,MEDLINE ,030204 cardiovascular system & hematology ,Patient care ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Key (cryptography) ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
[Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] Am I doing the right thing for my patient? Every day, cardiovascular clinicians grapple with the weight of that question, search for trusted guidance, and seek verification of the impact of their interventions on
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- 2020
14. Clinician Well-Being-Addressing Global Needs for Improvements in the Health Care Field: A Joint Opinion From the American College of Cardiology, American Heart Association, European Society of Cardiology, and the World Heart Federation
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Stephan Achenbach, Laxmi S. Mehta, Mitchell S.V. Elkind, Athena Poppas, and Fausto J. Pinto
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medicine.medical_specialty ,Health Services Needs and Demand ,business.industry ,Health Status ,Cardiology ,American Heart Association ,Quality Improvement ,United States ,Europe ,Physiology (medical) ,Family medicine ,Physicians ,Well-being ,Health care ,medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Burnout, Professional ,Delivery of Health Care ,Societies, Medical - Published
- 2021
15. The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology
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Fausto J. Pinto, Mitchell S.V. Elkind, Athena Poppas, Stephan Achenbach, and Jeffrey Willett
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medicine.medical_specialty ,Association (object-oriented programming) ,MEDLINE ,Cardiology ,Physiology (medical) ,tobacco ,Tobacco ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Chess endgame ,Epidemics ,Societies, Medical ,business.industry ,Tobacco Products ,Tobacco Use Disorder ,American Heart Association ,United States ,Europe ,Editorial ,Attitude ,Family medicine ,RC666-701 ,Public aspects of medicine ,RA1-1270 ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
16. Clinician Well-Being: Addressing Global Needs for Improvements in the Health Care Field: A Joint Statement from the American College of Cardiology, American Heart Association, European Society of Cardiology, and World Heart Federation
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Athena Poppas, Fausto J. Pinto, Stephan Achenbach, Laxmi S. Mehta, and Mitchell S.V. Elkind
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Community and Home Care ,medicine.medical_specialty ,burnout ,Epidemiology ,business.industry ,Statement (logic) ,Cardiology ,resiliency ,American Heart Association ,practice efficiency ,United States ,professional fulfillment ,Editorial ,well-being ,Family medicine ,Health care ,Well-being ,Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Societies, Medical - Published
- 2021
17. ACC Education Today
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Katie Berlacher and Athena Poppas
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,The Renaissance ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Classics ,Privilege (social inequality) - Abstract
[Figure][1] ![Figure][1] Like the prolific Renaissance artist Michelangelo, we too have chosen a profession in which we have the privilege and responsibility of saying, “I am still learning.” At every age and every stage of our careers, the pursuit of knowledge is indispensable
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- 2020
18. Global Health Commitment
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Athena Poppas
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business.industry ,Social connectedness ,MEDLINE ,030204 cardiovascular system & hematology ,Public relations ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Health care ,Global health ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
[Figure][1] It took a pandemic to remind us of our human connectedness and shared vulnerabilities. Indeed, in the words of Thomas Friedman, “the world is flat” ([1][2]). The depth and breadth of our society’s interdependence with other countries and cultures, with various health care
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- 2020
19. Cardiovascular Disease
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Athena Poppas
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0301 basic medicine ,Gerontology ,Life span ,business.industry ,Cardiovascular health ,MEDLINE ,Disease ,030105 genetics & heredity ,medicine.disease ,3. Good health ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Disease Presentation ,RC666-701 ,Health care ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Leadership Page ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
[Figure][1] Improving the cardiovascular health and quality of health care for women requires recognition and understanding of the differences across the woman’s life span, from pathophysiology of coronary artery disease involving sex-specific risk factors to disease presentation of
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- 2020
20. Global Prevalence and Impact of Hostility, Discrimination, and Harassment in the Cardiology Workplace
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Mary Norine Walsh, Roger S. Blumenthal, Sharonne N. Hayes, Pamela S. Douglas, Robert A. Harrington, Athena Poppas, Laxmi S. Mehta, Ranna Parekh, Roxana Mehran, MA Anne K. Rzeszut, Toniya Singh, and Garima Sharma
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Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Asia ,Cardiology ,Hostility ,030204 cardiovascular system & hematology ,Logistic regression ,Job Satisfaction ,03 medical and health sciences ,Middle East ,Physicians, Women ,0302 clinical medicine ,Internal medicine ,Surveys and Questionnaires ,medicine ,Prevalence ,media_common.cataloged_instance ,Humans ,030212 general & internal medicine ,European union ,Workplace ,media_common ,Aged ,business.industry ,Odds ratio ,Middle Aged ,South America ,Confidence interval ,Sexual Harassment ,Harassment ,Sexual orientation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Discrimination and emotional and sexual harassment create a hostile work environment (HWE). The global prevalence of HWE in cardiology is unknown, as is its impact.This study sought to evaluate emotional harassment, discrimination, and sexual harassment experienced by cardiologists and its impact on professional satisfaction and patient interactions worldwide.The American College of Cardiology surveyed cardiologists from Africa, Asia, the Caribbean, Eastern Europe, the European Union, the Middle East, Oceana, and North, Central, and South America. Demographics, practice information, and HWE were tabulated and compared, and their impact was assessed. The p values were calculated using the chi-square, Fisher exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analysis determined the association of characteristics with HWE and its subtypes.Of 5,931 cardiologists (77% men; 23% women), 44% reported HWE. Higher rates were found among women (68% vs. 37%; odds ratio [OR]: 3.58 vs. men), Blacks (53% vs. 43%; OR: 1.46 vs. Whites), and North Americans (54% vs. 38%; OR: 1.90 vs. South Americans). Components of HWE included emotional harassment (29%; n = 1,743), discrimination (30%; n = 1,750), and sexual harassment (4%; n = 221), and they were more prevalent among women: emotional harassment (43% vs. 26%), discrimination (56% vs. 22%), and sexual harassment (12% vs. 1%). Gender was the most frequent cause of discrimination (44%), followed by age (37%), race (24%), religion (15%), and sexual orientation (5%). HWE adversely affected professional activities with colleagues (75%) and patients (53%). Multivariate analysis showed that women (OR: 3.39; 95% confidence interval: 2.97 to 3.86; p 0.001) and cardiologists early in their career (OR: 1.27; 95% confidence interval: 1.14 to 1.43; p 0.001) had the highest odds of experiencing HWE.There is a high global prevalence of HWE in cardiology, including discrimination, emotional harassment, and sexual harassment. HWE has an adverse effect on professional and patient interactions, thus confirming concerns about well-being and optimizing patient care. Institutions and practices should prioritize combating HWE.
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- 2021
21. Insights from the Menstrual Cycle in Pulmonary Arterial Hypertension
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Mark S. Dooner, Thomas Walsh, Margaret R. MacLean, Athena Poppas, Jason M. Aliotta, Elizabeth O. Harrington, Melissa Allahua, Corey E. Ventetuolo, Grayson L. Baird, Christopher J Mullin, Alexander S. Brodsky, James R. Klinger, Mandy Pereira, Nina Denver, Mary Whittenhall, Ruth Andrew, and Ghada Bourjeily
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Pulmonary and Respiratory Medicine ,RM ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,media_common.quotation_subject ,Physiology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Dehydroepiandrosterone sulfate ,medicine ,Humans ,030212 general & internal medicine ,Gonadal Steroid Hormones ,Menstrual cycle ,Menstrual Cycle ,media_common ,Original Research ,Pulmonary Arterial Hypertension ,business.industry ,medicine.disease ,Pulmonary hypertension ,030228 respiratory system ,chemistry ,Observational study ,Female ,business ,Hormone - Abstract
Rationale: Sex hormones play a role in pulmonary arterial hypertension (PAH), but the menstrual cycle has never been studied. Objectives: We conducted a prospective observational study of eight women with stable PAH and 20 healthy controls over one cycle. Methods: Participants completed four study visits 1 week apart starting on the first day of menstruation. Relationships between sex hormones, hormone metabolites, and extracellular vesicle microRNA (miRNA) expression and clinical markers were compared with generalized linear mixed modeling. Results: Women with PAH had higher but less variable estradiol (E2) levels (P
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- 2021
22. Is Maternal Obesity the Achilles' Heel of Sustainable Efforts to Reduce Adverse Pregnancy Outcomes?
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Athena Poppas, Garima Sharma, and Roger S. Blumenthal
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medicine.medical_specialty ,Heel ,business.industry ,Pregnancy Outcome ,medicine.disease ,Obesity ,Obesity, Maternal ,medicine.anatomical_structure ,Pre-Eclampsia ,Pregnancy ,medicine ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,Pregnancy outcomes ,business ,Cardiovascular outcomes - Published
- 2021
23. NCDR: Advancing Patient Care, Outcomes, and Value Through Innovation and Knowledge
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Athena Poppas and Frederick A. Masoudi
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medicine.medical_specialty ,business.industry ,MEDLINE ,Cardiology ,Patient care ,Outcome Assessment, Health Care ,Medicine ,Humans ,Patient Care ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Value (mathematics) ,Societies, Medical - Published
- 2021
24. Echocardiography for the Diagnosis and Management of Acute Aortic Syndromes
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Sumbal Janjua, Andrew Maslow, and Athena Poppas
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Aortic dissection ,Aortic arch ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Abdominal aorta ,Transesophageal echocardiogram ,medicine.disease ,medicine.anatomical_structure ,medicine.artery ,Internal medicine ,Ascending aorta ,cardiovascular system ,medicine ,Cardiology ,Thoracic aorta ,Esophagus ,Transthoracic echocardiogram ,business - Abstract
Echocardiography provides both qualitative and quantitative evaluation of the aortic root, thoracic and proximal abdominal aorta. Transthoracic echocardiography (TTE) provides good views of the aortic root and proximal abdominal aorta, adequate views of the proximal ascending aorta and aortic arch, while only limited views of the descending thoracic aorta, in some patients. Transesophageal echocardiography (TEE), with its superior image quality due to high frequency transducers and close approximation of the esophagus to the thoracic aorta, provides nearly complete assessment of the ascending and descending thoracic aorta, especially in the emergency evaluation of Acute Aortic Syndromes (AAS). Presence of the trachea/left bronchus impedes complete visualization of the distal ascending aorta and proximal aortic arch.
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- 2021
25. The Tobacco Endgame—Eradicating a Worsening Epidemic
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Mitchell S.V. Elkind, Stephan Achenbach, Jeffrey Willett, Athena Poppas, and Fausto J. Pinto
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Community and Home Care ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Smoking prevention ,MEDLINE ,Smoking Prevention ,Tobacco Products ,Nicotine ,Special Article ,Family medicine ,Tobacco ,Humans ,Medicine ,AcademicSubjects/MED00200 ,Intensive care medicine ,Epidemics ,Cardiology and Cardiovascular Medicine ,business ,Chess endgame ,medicine.drug - Published
- 2021
26. Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment
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Robert A. Harrington, Dan M. Roden, Andrea M. Russo, and Athena Poppas
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Drug ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,media_common.quotation_subject ,Pneumonia, Viral ,Torsades de pointes ,Azithromycin ,QT interval ,Betacoronavirus ,Heart Rate ,Torsades de Pointes ,Physiology (medical) ,Pandemic ,medicine ,Humans ,Drug Interactions ,Pandemics ,media_common ,biology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Arrhythmias, Cardiac ,biology.organism_classification ,medicine.disease ,Virology ,COVID-19 Drug Treatment ,Pneumonia ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business ,Hydroxychloroquine - Published
- 2020
27. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic
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Joseph A. Dearani, Alan B. Packard, Vasken Dilsizian, Ehtisham Mahmud, John G. Webb, Sean A. Virani, David A. Wood, Sharmila Dorbala, Janarthanan Sathananthan, Andrea M. Russo, James Carr, Alice Virani, Athena Poppas, Madhav Swaminathan, Jean Francois Legare, Andrew D. Krahn, Jonathon Leipsic, Kenneth Gin, Vinod H. Thourani, Ron Blankstein, and Robert A. Harrington
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Cardiac computed tomography ,Distancing ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Medical care ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pandemic ,medicine ,030212 general & internal medicine ,Intensive care medicine ,Coronavirus ,biology ,business.industry ,Public health ,biology.organism_classification ,030228 respiratory system ,Surgery ,business ,Cardiology and Cardiovascular Medicine ,Betacoronavirus - Abstract
The coronavirus disease-2019 (COVID-19) pandemic has led to marked global morbidity and mortality ([1–3][1]). There have been appropriate but significant restrictions on routine medical care to comply with public health guidance on physical distancing and to help preserve or redirect limited
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- 2020
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28. Telehealth Is Having a Moment
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Jeffrey D. Wessler, Athena Poppas, and John S. Rumsfeld
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Telehealth ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Medicine ,030212 general & internal medicine ,Wearable Electronic Device ,business ,Cardiology and Cardiovascular Medicine - Abstract
[Figure][1] ![Figure][1] ![Figure][1] The past few months of the coronavirus disease-2019 (COVID-19) outbreak have brought seismic shifts in the fabric of our lives and in medicine. As clinicians, health care systems and communities have risen to the challenge of providing
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- 2020
- Full Text
- View/download PDF
29. Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: a survey by the European Society of Cardiology
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Guilherme Pessoa-Amorim, Athena Poppas, Stephan Achenbach, Cécile Laroche, Aldo P. Maggioni, Parag R Gajendragadkar, Chris P Gale, Franz Weidinger, Barbara Casadei, José Luis Zamorano, Christian F. Camm, Giovanni Luigi De Maria, and Celine Arsac
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Pneumonia, Viral ,Cardiology ,030204 cardiovascular system & hematology ,European Society of Cardiology ,Time-to-Treatment ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Internal medicine ,Surveys and Questionnaires ,Health care ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,cardiovascular diseases ,Pandemics ,business.industry ,SARS-CoV-2 ,Health Policy ,Outbreak ,COVID-19 ,Thrombolysis ,medicine.disease ,Policy planning ,Management ,Hospitalization ,Leadership ,ST-elevation myocardial infarction ,Editorial ,Health Care Surveys ,Conventional PCI ,ST Elevation Myocardial Infarction ,Original Article ,business ,Coronavirus Infections ,Emergency Service, Hospital ,Cardiology and Cardiovascular Medicine ,Facilities and Services Utilization - Abstract
Aims The COVID-19 pandemic required a significant redeployment of worldwide healthcare resources. Fear of infection, national lockdowns and altered healthcare priorities have the potential to impact utilisation of healthcare resources for non-communicable diseases. To survey health professionals’ views of the impact of the COVID-19 pandemic on the rate and timing of admission of patients with ST-elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) administered an internet-based questionnaire to cardiologists and cardiovascular nurses across 6 continents. Methods and results 3101 responses were received from 141 countries across 6 continents. 88.3% responded that their country was in “total lockdown” and 7.1% in partial lockdown. 78.8% responded that the number of patients presenting with STEMI was reduced since the coronavirus outbreak and 65.2% indicated that the reduction in STEMI presentations was >40%. Approximately 60% of all respondents reported that STEMI patients presented later than usual and 58.5% that >40% of STEMI patients admitted to hospital presented beyond the optimal window for primary percutaneous intervention (PCI) or thrombolysis. Independent predictors of the reported higher rate of delayed STEMI presentation were a country in total lockdown, >100 COVID-19 cases admitted locally, and the complete restructuring of the local cardiology service. Conclusion The survey indicates that the impact of COVID-19 on STEMI presentations is likely to be substantial, with both lower presentations and a higher rate of delayed presentations occurring. This has potentially important ramifications for future healthcare and policy planning in the event of further waves of this pandemic.
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- 2020
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30. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership
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James Carr, Robert A. Harrington, Vinod H. Thourani, Joseph A. Dearani, Andrea M. Russo, Alan B. Packard, Sean A. Virani, Jean Francois Legare, David A. Wood, Vasken Dilsizian, Kenneth Gin, Ron Blankstein, Andrew D. Krahn, Jonathon Leipsic, Janarthanan Sathananthan, John G. Webb, Alice Virani, Athena Poppas, Ehtisham Mahmud, Madhav Swaminathan, and Sharmila Dorbala
- Subjects
Male ,COVID-19 Pandemic ,Cardiovascular Procedures ,030204 cardiovascular system & hematology ,Medical care ,Occupational safety and health ,0302 clinical medicine ,PPE, Personal Protective Equipment ,Outcome Assessment, Health Care ,Pandemic ,PPCI, Primary percutaneous coronary intervention ,TAVR, Transcatheter aortic valve replacement ,TEVAR, Thoracic endovascular aortic repair ,Medicine ,030212 general & internal medicine ,CHF, Congestive Heart Failure ,PFO, Patent foramen ovale ,Societies, Medical ,EVAR, Endovascular repair of aortic aneurysm ,Cardiac Magnetic Resonance Imaging ,TTE, Transthoracic echocardiography ,Cardiovascular Surgery ,AGMP, Aerosol-generating medical procedure ,Health Services ,Interventional Cardiology ,Cardiac Commuted Tomography ,Electrophysiology ,TEE, Transesophageal echocardiography ,LAAC, Left atrial appendage closure ,Echocardiography ,UA, Unstable angina ,Female ,Patient Safety ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,Coronavirus Infections ,Safety Management ,medicine.medical_specialty ,Infectious Disease Transmission, Patient-to-Professional ,Consensus ,Coronavirus disease 2019 (COVID-19) ,Distancing ,Pneumonia, Viral ,Cardiology ,ASD, Atrial septal defect ,Article ,03 medical and health sciences ,Patient safety ,Betacoronavirus ,STEMI, ST elevation myocardial infarction ,Nursing ,Diagnostic Tests ,Humans ,CV, Cardiovascular ,Personal protective equipment ,Pandemics ,Occupational Health ,business.industry ,SARS-CoV-2 ,Public health ,COVID-19 ,HCW, Health care workers ,NSTEMI, Non-ST elevation myocardial infraction ,Leadership ,North America ,MI, Myocardial infarction ,business ,Nuclear Cardiac Imaging - Abstract
The coronavirus disease-2019 (COVID-19) pandemic has led to marked global morbidity and mortality ([1–3][1]). There have been appropriate but significant restrictions on routine medical care to comply with public health guidance on physical distancing and to help preserve or redirect limited
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- 2020
31. Abstract WMP66: Left Atrial Appendage Flow Velocity is Associated With Ischemic Events and Brain Infarcts in Atrial Fibrillation
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Mahesh V Jayaraman, Antony Chu, Christopher Song, Karen L. Furie, Tina Burton, Nikhil Panda, Brian MacGrory, Michael Wu, Athena Poppas, Andrew D Chang, Shadi Yaghi, Michael K. Atalay, Shawna Cutting, and Gian Ignacio
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Advanced and Specialized Nursing ,Appendage ,medicine.medical_specialty ,business.industry ,Atrial fibrillation ,Context (language use) ,medicine.disease ,Flow velocity ,Left atrial ,Internal medicine ,Ischemic stroke ,Cardiology ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: Clinical predictors of ischemic stroke in the setting of atrial fibrillation (AF) have been identified, but there is limited data on predictors in the context of abnormal flow originating from the left atrial appendage. We hypothesize that reduced LAA flow velocity is associated with cerebrovascular ischemic events in patients with AF. Methods: We investigated consecutive patients with AF evaluated for ablation. Peak flow velocities at the orifice of the left atrial appendage (LAA) were obtained by transeosphageal echocardiography (TEE) studies, and elevated velocities were defined as greater than 40 cm/sec, in line with prior studies. The primary outcome was defined as the presence of any of the following: history of stroke/transient ischemic event, or non-lacunar brain infarct on brain imaging performed before the TEE. Univariate and multivariable analyses were performed to determine the association between LAA peak flow and the primary outcome, adjusting for CHADS2Vasc score. Results: We identified 322 patients with TEE performed. The mean age was 62.1 years and 24.5% men. Patients with LAA-flow velocity < 40 cm/sec were more likely to have the primary outcome (10.7% vs 4.3%, p=0.023). This association persisted after adjusting for CHADS2VASc (OR, 2.62; 95% CI, 1.09-6.33, p = 0.032). Conclusion: Low velocity in the LAA is associated with cerebrovascular ischemic events in patients with AF. More studies are needed to deterine whether LAA flow velocity can help risk stratify “low risk” patients with AF.
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- 2020
32. Abstract WMP70: Increased Left Atrial Appendage Density on Computerized Tomography is Associated With Cardioembolic Stroke
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Mahesh V Jayaraman, Shawna S. Cutting, Alexander E Merkler, Brian Mac Grory, Hooman Kamel, Tina Burton, Ronald K. Akiki, Shadi Yaghi, Athena Poppas, Gian Ignacio, Mitchell S.V. Elkind, Karen L. Furie, Christopher Song, and Andrew D Chang
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Advanced and Specialized Nursing ,Appendage ,medicine.medical_specialty ,Cardioembolic stroke ,business.industry ,Stroke risk ,Left atrial ,Internal medicine ,Ischemic stroke ,medicine ,Cardiology ,Neurology (clinical) ,Tomography ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose: While studies have stratified cardioembolic (CE) stroke risk by qualitative left atrial appendage (LAA) morphology and biomarkers of atrial dysfunction, the quantitative properties that underlie these observations are not well established. Accordingly, we hypothesized that LAA volume and contrast density (attenuation) on computerized tomography (CT) may capture the structural and hemodynamic processes that underlie CE stroke risk. Methods: Data were collected from a single center prospective ischemic stroke database over 18 months and included all patients with ischemic stroke who previously underwent routine, non-gated, contrast enhanced thin-slice (≤2.5 mm) chest CT. Stroke subtype was determined based on the inpatient diagnostic evaluation. LAA volume and attenuation were determined from CT studies performed for various clinically appropriate indications. Univariate and multivariable analyses were performed to determine factors associated with ischemic stroke subtype, including known risk factors and biomarkers, as well as LAA density and morphologic measures. Results: We identified 311 patients with a qualifying chest CT (119 CE subtype, 109 ESUS, and 83 non-CE). In unadjusted models, there was an association between CE (vs. non-CE) stroke subtype and LAA volume (OR per mL increase 1.15, 95% CI 1.07-1.24, pth quartile vs. 1 st quartile; OR 2.95, 95% CI 1.28-6.80, p=0.011), but not with ESUS (vs. non-CE) subtype. In adjusted models, only the association between LAA density and CE stroke subtype persisted (adjusted OR 3.71, 95% CI 1.37-10.08, p=0.010). Conclusion: The LAA volume and density values on chest CT are associated with CE stroke subtype but not ESUS subtype. Patients with ESUS and increased LAA volume or attenuation may be a subgroup where the mechanism is cardioembolic and anticoagulation can be tested for secondary stroke prevention.
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- 2020
33. Impact of Live, Scientific Annual Meetings in Today’s Cardiovascular World
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Jeffrey T. Kuvin, Andrew M. Kates, Pamela J. Morris, and Athena Poppas
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Focus (computing) ,Information Dissemination ,business.industry ,Interprofessional Relations ,Lifelong learning ,Cardiology ,Congresses as Topic ,030204 cardiovascular system & hematology ,Public relations ,03 medical and health sciences ,0302 clinical medicine ,Inventions ,Humans ,Medicine ,Professional association ,030212 general & internal medicine ,Diffusion of Innovation ,Cardiology and Cardiovascular Medicine ,business ,Forecasting - Abstract
Annual live meetings are a focus for many organizations and professional societies and have long been considered an essential part of lifelong learning. Live meetings offer a venue for a wide range of topics including late breaking science, traditional and novel educational formats, networking opportunities, integration of technology, engagement of the cardiovascular team, and more. Although many factors provide challenges for the future of live annual meetings, there are many opportunities as well. The unique aspects of interactions and experiences at these meetings will maintain their importance in the lifelong learning toolbox.
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- 2018
34. Can Early Management of Hypertension by General Practitioners Improve Outcome?
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Deborah L Nadler and Athena Poppas
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Cardiomyopathy ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Outcome (game theory) ,03 medical and health sciences ,0302 clinical medicine ,lcsh:RC666-701 ,Internal medicine ,Diabetes mellitus ,Heart failure ,RC666-701 ,Angiography ,Cardiology ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Hypertension and its cardiovascular sequelae remain one of the major causes of death and disability worldwide, and the prevalence of hypertension in the US and Europe is high. Hypertension is a leading modifiable risk factor for cardiovascular events. Pharmacological approaches and lifestyle modification to treat hypertension early have been consistently shown to improve cardiovascular outcomes in primary and secondary prevention. Recent guidelines recommend initiating treatment at lower blood pressure levels, with normal blood pressure being defined as
- Published
- 2019
35. Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa: A Case Series with Literature Review
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Philip Stockwell, Athena Poppas, Eirini Apostolidou, and Charles Beale
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medicine.medical_specialty ,Valve surgery ,Left atrium ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,Internal medicine ,medicine.artery ,Mitral-aortic intervalvular fibrosa ,Medicine ,Endocarditis ,Ventricular outflow tract ,cardiovascular diseases ,030212 general & internal medicine ,ComputingMethodologies_COMPUTERGRAPHICS ,Aorta ,business.industry ,Sequela ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Post-Operative Problem ,Echocardiography ,cardiovascular system ,Cardiology ,Radiology ,Presentation (obstetrics) ,business - Abstract
Graphical abstract, Highlights • P-MAIVF is usually a complication of endocarditis or aortic valve surgery. • It is promptly recognized on transesophageal echocardiography. • It may cause symptoms and complications that warrant surgical intervention. • Surgical intervention remains the recommended management for P-MAIVF.
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- 2017
36. Echocardiographic Pulmonary Hypertension Predicts Post-transplantation Renal Allograft Failure
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Paul E. Morrissey, Grayson L. Baird, James R. Klinger, Reginald Y. Gohh, Athena Poppas, A. Bazargan-Lari, Corey E. Ventetuolo, and Andrew Foderaro
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Adult ,Male ,medicine.medical_specialty ,Hypertension, Pulmonary ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Proportional Hazards Models ,Retrospective Studies ,Transplantation ,Creatinine ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Pulmonary hypertension ,Post transplant ,Confidence interval ,030228 respiratory system ,chemistry ,Echocardiography ,Preoperative Period ,Cardiology ,Renal allograft ,Female ,Surgery ,Hemodialysis ,Primary Graft Dysfunction ,business - Abstract
Background Pulmonary hypertension in the setting of renal transplantation has been associated with early allograft dysfunction and increased mortality, but this relationship has not been extensively studied. Methods We performed a retrospective cohort study of adult patients who underwent their first renal transplantation in the years 2003–2009 and had pre-transplantation echocardiograms. Pulmonary hypertension was defined as right ventricular systolic pressure ≥40 mm Hg in the absence of left-sided valvular disease and/or left ventricular ejection fraction ≤50%. Eighty-two of 205 patients (40%) met the inclusion criteria. The relationship between pulmonary hypertension and death-censored allograft failure (hemodialysis dependence or retransplantation) and serum creatinine was assessed with the use of Cox hazard regression and generalized mixed models. Results The presence of pulmonary hypertension was associated with a 3-fold increase in the risk of death-censored allograft failure (95% confidence interval, 1.20–7.32; P = .02). Failure rates were 19% at 24 months and 51% at 96 months for those with pulmonary hypertension versus 7% at 24 months and 20% at 86 months for those without pulmonary hypertension ( P = .01). Among those without graft failure, there was an increase in creatinine levels after transplantation ( P = .01). Effect estimates were unchanged by adjustment for multiple covariates and when pulmonary hypertension was defined as right ventricular systolic pressure ≥36 mm Hg. Conclusions Pulmonary hypertension before renal transplantation carries a 3-fold increased risk of death-censored allograft failure. The relationship between the pulmonary circulation and renal allograft failure warrants further study.
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- 2017
37. Representation of Women in American College of Cardiology/American Heart Association Guideline Writing Committees
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Amartya Kundu, Athena Poppas, Partha Sardar, and J. Dawn Abbott
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medicine.medical_specialty ,business.industry ,Advisory Committees ,Cardiology ,American Heart Association ,Guideline ,030204 cardiovascular system & hematology ,United States ,Representation (politics) ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Education, Medical, Graduate ,Family medicine ,Practice Guidelines as Topic ,medicine ,Humans ,Women's Rights ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Association (psychology) ,business - Abstract
[Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] Although progress has been made toward reducing gender disparities in clinical practice, the under-representation of women in cardiovascular (CV) medicine remains a concern. With respect to women in the physician
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- 2018
38. Rheumatic Heart Disease in Pregnancy
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Katharine French and Athena Poppas
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medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve stenosis ,Pregnancy ,Physiology (medical) ,Internal medicine ,Mitral valve ,Angioplasty ,medicine ,Humans ,Mitral Valve Stenosis ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Mitral regurgitation ,business.industry ,Pregnancy Outcome ,Rheumatic Heart Disease ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business - Abstract
Acute rheumatic fever and rheumatic valvular disease remain prevalent in many parts of the world, and are probably the most common cause of heart disease in pregnancy. Mitral stenosis is the most frequently encountered rheumatic valvular lesion. A variety of pregnancy-associated cardiovascular changes often exacerbate the signs and symptoms of valvular lesions. Pregnancy should not be allowed to proceed, if possible, in patients with uncorrected severe valvular lesions or mechanical heart valves requiring anticoagulation, as maternal and fetal morbidity and mortality are high. For those with milder disease, pregnancy is best undertaken after the valvular lesion has been rectified or stabilised. Recent advances in the management of valvular disease include the use of beta-blockers for patients with mitral stenosis, vasodilators in those with aortic and mitral regurgitation, and percutaneous balloon valvuloplasty for mitral and aortic stenosis. Application of these therapies in the pregnant patient is as yet unclear, and management decision needs to be individualized, weighing the risk and benefit to ensure maternal survival and to promote fetal well-being.
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- 2018
39. Sex Differences in Cardiovascular Disease and Cognitive Impairment: Another Health Disparity for Women?
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Hena N. Patel, Shari R. Waldstein, Neelum T. Aggarwal, Jeremy N. Ruskin, C. Noel Bairey Merz, T. Jared Bunch, Nanette K. Wenger, Vera Bittner, Pauline M. Maki, Carl J. Pepine, Athena Poppas, Annabelle Santos Volgman, Kristine Yaffe, Andrea M. Russo, and Philip B. Gorelick
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Adult ,Male ,Gerontology ,Aging ,complication ,Disease ,030204 cardiovascular system & hematology ,Cardiovascular System ,Risk Assessment ,Genetic, Association Studies ,03 medical and health sciences ,Cognition ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Cardiovascular Disease ,Contemporary Review ,Humans ,Medicine ,Dementia ,Cognitive Dysfunction ,Women ,030212 general & internal medicine ,Healthcare Disparities ,Cognitive decline ,Vascular dementia ,Cognitive deficit ,Aged ,business.industry ,cardiac procedures ,Age Factors ,Health Status Disparities ,Middle Aged ,Prognosis ,medicine.disease ,ischemic heart disease ,Cognitive test ,Cardiovascular Diseases ,Women's Health ,Female ,strokes ,Alzheimer disease ,Alzheimer's disease ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,APOE ,dementia - Abstract
Although the number of Americans dying of cardiovascular disease (CVD) continues to increase since 2010 after decades of decrease, advances in the management of CVD have led to increased longevity among both women and men, with more people, mostly women, now surviving into their 80s and beyond.1 Paralleling this increased longevity, however, is an increasing prevalence of, and mortality from, neurodegenerative cognitive disorders.1 These cognitive disorders include dementia, a syndrome that has a multitude of causes and symptoms that ultimately have substantial impact on social and occupational activities and aspects of daily living.2 Typical symptoms of dementia include changes in memory, problem solving, language, and executive functioning.2 Although there are often distinct patterns, symptoms, and specific brain pathology associated with different dementias, multiple autopsy studies are now demonstrating that people with symptoms of a dementia will often have multiple brain pathologies noted at autopsy that were associated with the dementia.3, 4 Multiple reports document that approximately two thirds of those clinically diagnosed with Alzheimer dementia are women.5 Furthermore, it is estimated that by 2040 the number of Americans with some form of cognitive impairment (CI), including dementia, will be ≈8.3 million women and ≈3.3 million men.5 This sex‐related CI disparity is concerning and raises important questions about its possible relation to CVD and CVD‐related risk factor conditions. Although there are multiple types of dementia syndromes with different cognitive, behavioral, and pathological characteristics, the most common types are Alzheimer dementia and vascular cognitive impairment.6 Alzheimer dementia is characterized by an irreversible, progressive disorder that slowly destroys memory and thinking skills, and eventually the ability to perform simple tasks.7 Vascular cognitive impairment, a term that encompasses all levels of CI from its mildest form to vascular dementia, is characterized by progressive changes in behavior, function, and cognition caused by vascular injury (eg, strokes [infarcts], microbleeds [cerebral amyloid angiopathy and microhemmorhages]) or disease within the brain and includes deficits in executive functioning, attention, and language. This is in contrast to episodic memory deficits, which are more prominent in Alzheimer dementia. Increasingly, the term “mixed dementia” is used to describe the coexistence of both Alzheimer disease (AD) and vascular neuropathology in people experiencing dementia symptoms.8 In 2018, new criteria for AD were established by the National Institute on Aging and Alzheimer's Association to recognize that the disease occurs across a continuum of pathologic changes that precede its clinical manifestations and culminates with Alzheimer dementia.9 The clinical syndrome is noted as Alzheimer dementia, and the term dementia caused by AD is used when neuroimaging biomarkers or biofluid markers or autopsy confirm the diagnosis. This distinction continues to highlight the ongoing research that shows that AD begins many years before the symptoms of Alzheimer dementia are present.10 The term mild cognitive impairment (MCI) is used in people with demonstrable CI who have not crossed the threshold to dementia. MCI can refer to either a predominantly memory (amnestic) or nonmemory (nonamnestic) cognitive deficit and can be the initial symptom of a dementia syndrome, but it may also be secondary to other conditions or disease processes.11 A meta‐analysis revealed that women have a higher prevalence of nonamnestic MCI but suggested no sex‐related differences in the incidence or prevalence of amnestic MCI.12 At age 45 years, the lifetime risk for developing Alzheimer dementia is estimated at 1 in 5 for women versus only 1 in 10 for men.13 Possible reasons for this sex disparity, alone or more likely in combination, include greater longevity of women; their higher incidence of chronic diseases (particularly those CVD linked with CI), genetic predispositions, differences in cognitive testing performance (women outperform men on tests of verbal ability)14 (thereby potentially “masking” any underlying cognitive deficits, resulting in a later presentation to the healthcare provider for complaints of change in cognitive function), socioeconomic, psychosocial, and biological factors.15 Education level and occupational attainment (eg employment) can impact cognitive resilience and explain some of the sex disparities noted in dementia.16, 17 Traditionally, older women may not have had as many opportunities for attaining a higher level of education nor an equal period of time in the workforce compared with men, thus possibly putting them at an increased risk for developing cognitive decline and dementia. However, results from studies continue to be mixed, as methodological issues, study design, and comparability across studies remain difficult. Lastly, among the psychosocial factors, caregiving has emerged as a potential risk factor for developing dementia. Sex differences in spousal care are highly prevalent for patients with dementia, with women delivering the majority of the care and spending more time devoted to care.18 The increased stress of caregiving, coupled with lower levels of social support and poor physical health, are increasingly being examined as strong risk factors for cognitive decline and dementia in female caregivers. In addition to the aforementioned contributing factors of sex‐related differences in the dementia syndromes, this review examines sex differences in CVD and a broad range of CVD risk factors that may contribute to CI to explain, at least in part, the higher prevalence of dementias in women versus men. Potential implications of these sex differences are addressed in context for practitioners, our healthcare system, and related resource consumption. Important knowledge gaps are identified to direct the focus of future research. The American College of Cardiology CVD in Women Committee identified this topic and invited experts in the fields of CVD and/or CI to contribute sections in their respective fields. They did their own literature searches and submitted their sections to the chair of the writing committee (ASV), who compiled and summarized the sections to create a cohesive document. Over 300 selected publications were reviewed, and those addressing sex differences or new information were included in this document. This document is a summary of the topics that include stroke, microvascular or small‐vessel disease, and sex‐specific issues about differences in CVD that may help explain the increased prevalence of CI and dementia in women.
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- 2019
40. Sensitivity and Specificity of B-Type Natriuretic Peptide in Diagnosing Heart Failure in Pregnancy
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Christopher Thomas Nau, Isabelle Malhamé, Heather Hurlburt, Ghada Bourjeily, Athena Poppas, Lucia Larson, and Niharika Mehta
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Adult ,medicine.medical_specialty ,medicine.drug_class ,Pregnancy Complications, Cardiovascular ,Likelihood ratios in diagnostic testing ,Sensitivity and Specificity ,Preeclampsia ,Interquartile range ,Pregnancy ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Medicine ,Humans ,Retrospective Studies ,Heart Failure ,Likelihood Functions ,Receiver operating characteristic ,business.industry ,Postpartum Period ,Obstetrics and Gynecology ,Retrospective cohort study ,medicine.disease ,ROC Curve ,Echocardiography ,Heart failure ,Cardiology ,Female ,business ,Postpartum period ,Biomarkers ,Maternal Serum Screening Tests - Abstract
OBJECTIVE To evaluate the performance of B-type natriuretic peptide as a diagnostic tool for heart failure in pregnant or postpartum women with singleton gestations. METHODS We conducted a retrospective study of diagnostic accuracy. We identified pregnant and postpartum women with B-type natriuretic peptide and echocardiography performed at an obstetric teaching hospital from 2007 to 2018. Women with known cardiac disease or multiple gestation were excluded. A panel of two cardiovascular disease experts, blinded to B-type natriuretic peptide values, determined the diagnosis of heart failure by consensus. Their judgement was based on detailed clinical features and parameters at the time of presentation with suspected heart failure. Where consensus could not be reached, differences were adjudicated by a third expert. A receiver operating characteristic curve estimated the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of B-type natriuretic peptide at various thresholds. RESULTS In total, 22 pregnant and 38 postpartum women were included in the cohort. Average age was 32±6.8 years. The most common clinical features at the time of presentation with suspected heart failure included preeclampsia (33/60, 55%), dyspnea (50/60, 83%), chest discomfort (34/60, 58%), and bilateral lower extremity edema (32/60, 53%). In total, 39 (65%) women had heart failure. The median B-type natriuretic peptide level was 326 pg/mL (interquartile range 200.5-390.5) in women with heart failure, as compared with 75.5 pg/mL (interquartile range 19-245) in women without heart failure (P
- Published
- 2019
41. Left Atrial Volume Index Is Associated With Cardioembolic Stroke and Atrial Fibrillation Detection After Embolic Stroke of Undetermined Source
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Mitchell S.V. Elkind, Shadi Yaghi, Karen L. Furie, Andrew D Chang, Shawna Cutting, Mahesh V Jayaraman, Kevin Jordan, Athena Poppas, M. Khaled Sabeh, Georgios Tsivgoulis, Hooman Kamel, Brian Mac Grory, Tina Burton, Alexander E Merkler, and Christopher Song
- Subjects
Male ,medicine.medical_specialty ,Neurology ,medicine.medical_treatment ,Logistic regression ,Article ,Internal medicine ,Atrial Fibrillation ,medicine ,Left atrial enlargement ,Humans ,cardiovascular diseases ,Heart Atria ,Prospective cohort study ,Stroke ,Advanced and Specialized Nursing ,business.industry ,Atrial fibrillation ,Odds ratio ,medicine.disease ,Intracranial Embolism ,Cardiology ,Female ,Neurology (clinical) ,Cardiac monitoring ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Abstract
Background and Purpose— Left atrial enlargement has been shown to be associated with ischemic stroke, but the association with embolic stroke mechanisms remains unknown. We aim to study the associations between left atrial volume index (LAVI) and embolic stroke subtypes and atrial fibrillation (AF) detection on cardiac event monitoring in patients with embolic stroke of unknown source. Methods— Data were collected from a prospective cohort of consecutive patients with ischemic stroke admitted to a comprehensive stroke center over 18 months. Stroke subtype was classified into cardioembolic stroke, noncardioembolic stroke of determined mechanism (NCE), or embolic stroke of undetermined source (ESUS). Univariate and prespecified multivariable analyses were performed to assess associations between LAVI and stroke subtype and AF detection in patients with ESUS. Results— Of 1224 consecutive patients identified during the study period, 1020 (82.6%) underwent transthoracic echocardiography and had LAVI measurements. LAVI was greater in patients with cardioembolic stroke than NCE (41.4 mL/m 2 ±18.0 versus 28.6 mL/m 2 ±12.2; P 2 ±12.6 versus 28.6 mL/m 2 ±12.2; P =0.61). In multivariable logistic regression models, LAVI was greater in cardioembolic stroke versus NCE (adjusted odds ratio per mL/m 2 , 1.07; 95% CI, 1.05–1.09; P 2 , 1.00; 95% CI, 0.99–1.02; P =0.720). Among 99 patients with ESUS who underwent cardiac monitoring, 18.2% had AF detected; LAVI was independently associated with AF detection in ESUS (adjusted odds ratio per mL/m 2 , 1.09; 95% CI, 1.02–1.15; P =0.007). Conclusions— LAVI is associated with cardioembolic stroke as well as AF detection in patients with ESUS, 2 subsets of ischemic stroke that benefit from anticoagulation therapy. Patients with increased LAVI may be a subgroup where anticoagulation may be tested for stroke prevention.
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- 2019
42. Burnout and Career Satisfaction Among U.S. Cardiologists
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Pamela S. Douglas, Philip F. Binkley, Laxmi S. Mehta, Claire S. Duvernoy, Mary Norine Walsh, Sandra J. Lewis, Anne K. Rzeszut, Robert A. Harrington, Mark Linzer, and Athena Poppas
- Subjects
Male ,Physician burnout ,business.industry ,fungi ,Workload ,Population health ,030204 cardiovascular system & hematology ,Burnout ,Career satisfaction ,United States ,03 medical and health sciences ,0302 clinical medicine ,Cardiologists ,Nursing ,Health care ,Medicine ,Humans ,Job satisfaction ,Female ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Productivity ,Burnout, Professional - Abstract
Physician burnout has a negative impact on patient care, productivity and job retention, whereas the cost of recruiting and replacing burned-out physicians can be steep [(1)][1]. The current health care environment places strong emphasis on accomplishing the triple aim: improving population health
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- 2019
43. The left atrial appendage morphology is associated with embolic stroke subtypes using a simple classification system: A proof of concept study
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Christopher Song, Mahesh V Jayaraman, Alexander E Merkler, Karen L. Furie, Shawna Cutting, Morgan Hemendinger, Ronald K. Akiki, Ashley Schomer, Scott Collins, Athena Poppas, Tina Burton, Michael K. Atalay, Hooman Kamel, Mitchell S.V. Elkind, Brain Mac Grory, Shadi Yaghi, Tracy Novack, Ryan A McTaggart, and Andrew D Chang
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,030204 cardiovascular system & hematology ,Proof of Concept Study ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Windsock ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Terminology as Topic ,Atrial Fibrillation ,medicine ,Prevalence ,Humans ,Radiology, Nuclear Medicine and imaging ,Atrial Appendage ,Stroke ,Aged ,Retrospective Studies ,Appendage ,Aged, 80 and over ,Observer Variation ,business.industry ,Incidence ,Reproducibility of Results ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Embolic stroke ,Intracranial Embolism ,Ischemic stroke ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Background and purpose The current left atrial appendage (LAA) classification system (cLAA-CS) categorizes it into 4 morphologies: chicken wing (CW), windsock, cactus, and cauliflower, though there is limited data on either reliability or associations between different morphologies and stroke risk. We aimed to develop a simplified LAA classification system and to determine its relationship to embolic stroke subtypes. Methods Consecutive patients with ischemic stroke from a prospective stroke registry who previously underwent a clinically-indicated chest CT were included. Stroke subtype was determined and LAA morphology was classified using the traditional system (in which CW = low risk) and a new system (LAA-H/L, in which low risk morphology (LAA-L) was defined as an acute angle bend or fold from the proximal/middle portion of the LAA and high risk morphology (LAA-H) was defined as all others). As a proof of concept study, we determined reliability for the two classification systems, and we assessed the associations between both classification systems with stroke subtypes in our cohort and previous studies. Results We identified 329 ischemic stroke patients with a qualifying chest CT (126 cardioembolic subtype, 116 embolic stroke of undetermined source (ESUS), and 87 non-cardioembolic subtypes). Intra- and inter-rater agreements improved using the LAA-H/L (0.95 and 0.85, respectively) vs. cLAA-CS (0.50 and 0.40). The LAA-H/L led to classifying 69 LAA morphologies that met criteria for CW as LAA-H. In fully adjusted models, LAA-H was associated with cardioembolic stroke (OR 5.4, 95%CI 2.1–13.7) and ESUS (OR 2.8 95% CI 1.2–6.4). Non-CW morphology was also associated with embolic stroke subtypes, but the effect size was much less pronounced. Studies using the cLAA-CS yielded mixed results for inter- and intra-rater agreements but most showed an association between a non-CW morphology and stroke with no difference among the three non-CW subtypes. Conclusion The LAA-H/L classification system is simple, has excellent intra and inter-rater agreements, and may help risk identify patients with cardioembolic stroke subtypes. Larger studies are needed to validate these findings.
- Published
- 2019
44. Abstract WMP72: High Risk Left Atrial Appendage Morphology (LAA-H) is Associated With Cardioembolic and Embolic Stroke of Unknown Source Subtypes
- Author
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Scott Collins, Hooman Kamel, Mitchell S.V. Elkind, Shawna Cutting, Brian Mac Grory, Ashley Schomer, Luigi Di Biase, Michael K. Atalay, Shadi Yaghi, Ronald K. Akiki, Morgan Hemendinger, Karen L. Furie, Tracy Novack, Tina Burton, Ryan A McTaggart, Alexander E Merkler, Athena Poppas, Christopher Song, and Andrew D Chang
- Subjects
Advanced and Specialized Nursing ,Appendage ,medicine.medical_specialty ,business.industry ,Atrial fibrillation ,medicine.disease ,Embolic stroke ,Unknown Source ,Left atrial ,Internal medicine ,medicine ,Cardiology ,In patient ,Neurology (clinical) ,Thrombus ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Background: The left atrial appendage (LAA) is the main source of thrombus in atrial fibrillation (AF); biomarkers of LAA dysfunction are associated with ischemic stroke (IS) risk in patients with AF. We hypothesized that high risk LAA features [High risk morphology (LAA-H), LAA volume (LAAV), and LAA orifice surface area (LAAOSA)] would be more prevalent among patients with cardioembolic (CE) stroke and embolic stroke of undetermined source (ESUS) than among those with non-cardioembolic stroke (NCS). Methods: Consecutive patients with IS from a prospective comprehensive stroke center registry who previously underwent a clinically-indicated qualifying chest CT were included. Patients underwent inpatient diagnostic evaluation for ischemic stroke, and stroke subtype was determined based on ESUS criteria. LAA morphology [Low risk morphology was defined as two lobes with an acute angle between them or chicken wing morphology and LAA-H defined as all others], LAAOSA (measured in a plane parallel to the left atrium), and LAAV (measured using a volumetric analysis software) were determined using contrast enhanced thin-slice chest CT (≤2.5 mm thickness) by investigators blinded to stroke subtype. Results: Of 1234 patients with ischemic stroke, 329 (26.7%) patients had a qualifying chest CT performed (126 CE, 116 ESUS, and 87 NCS). The baseline characteristics of patients with and without chest CT were similar. When compared to NCS, LAA-H was more prevalent in ESUS (86.4% vs. 70.1%, p=0.018) and CE stroke (82.5% vs. 70.1%, p=0.042). The LAAOSA and volume did not significantly differ between the 3 groups (Table). Conclusion: LAA characteristics associated with cardioembolic stroke are also more prevalent in patients with ESUS. Larger studies are needed to confirm that LAA features are a risk factor for stroke among patients without AF, and whether anticoagulation is effective in patients with high-risk LAA features.
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- 2019
45. Tissue-Based Markers of Right Ventricular Dysfunction in Ischemic Mitral Regurgitation Assessed via Stress Cardiac Magnetic Resonance and Three-Dimensional Echocardiography
- Author
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Meridith P. Pollie, Nathan H. Tehrani, Javid Alakbarli, Christiane M Abouzeid, Antonino Di Franco, Jonathan W. Weinsaft, Richard B. Devereux, Mark B. Ratcliffe, Jiwon Kim, Brian Yum, Robert A. Levine, and Athena Poppas
- Subjects
Male ,medicine.medical_specialty ,Ventricular Dysfunction, Right ,Ischemia ,Echocardiography, Three-Dimensional ,Myocardial Infarction ,Infarction ,030204 cardiovascular system & hematology ,Multimodal Imaging ,Article ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Prospective Studies ,Cardiac imaging ,Aged ,Tissue Survival ,Ejection fraction ,Ischemic mitral regurgitation ,Ventricular Remodeling ,business.industry ,Myocardium ,valvular heart disease ,Myocardial Perfusion Imaging ,Mitral Valve Insufficiency ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Preload ,Cardiology ,cardiovascular system ,Ventricular Function, Right ,Female ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
PURPOSE: Ischemic mitral regurgitation (iMR) augments risk for right ventricular dysfunction (RV(DYS)). Right and left ventricular (LV) function are linked via common coronary perfusion, but data is lacking regarding impact of LV ischemia and infarct transmurality – as well as altered preload and afterload – on RV performance. METHODS: In this prospective multimodality imaging study, stress CMR and 3-dimensional echo (3D-echo) were performed concomitantly in patients with iMR. CMR provided a reference for RV(DYS) (RVEF
- Published
- 2018
46. Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke
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Andrew D Chang, Michael K. Atalay, Karen L. Furie, Gian Ignacio, Brian Mac Grory, Ronald K. Akiki, Hooman Kamel, Mahesh V Jayaraman, Athena Poppas, Mitchell S.V. Elkind, Shawna S. Cutting, Christopher Song, Shadi Yaghi, Tina Burton, and Alexander E Merkler
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Heart Diseases ,Embolism ,Hemodynamics ,Single Center ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Left atrial ,Internal medicine ,medicine ,Humans ,Atrial Appendage ,Prospective Studies ,Stroke ,Aged ,Aged, 80 and over ,Cardioembolic stroke ,business.industry ,Rehabilitation ,Atrial fibrillation ,Middle Aged ,Stroke subtype ,Prognosis ,medicine.disease ,Cardiology ,Female ,Surgery ,Neurology (clinical) ,Tomography ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
While studies have stratified cardioembolic (CE) stroke risk by qualitative left atrial appendage (LAA) morphology and biomarkers of atrial dysfunction, the quantitative properties that underlie these observations are not well established. Accordingly, we hypothesized that LAA volume and contrast density (attenuation) on computerized tomography (CT) may capture the structural and hemodynamic processes that underlie CE stroke risk.Data were collected from a single center prospective ischemic stroke database over 18 months and included all patients with ischemic stroke who previously underwent routine, nongated, contrast enhanced thin-slice (≤2.5 mm) chest CT. Stroke subtype was determined based on the inpatient diagnostic evaluation. LAA volume and attenuation were determined from CT studies performed for various clinically appropriate indications. Univariate and multivariable analyses were performed to determine factors associated with ischemic stroke subtype, including known risk factors and biomarkers, as well as LAA density and morphologic measures.We identified 311 patients with a qualifying chest CT (119 CE subtype, 109 Embolic Stroke of Undetermined Source (ESUS), and 83 non-CE). In unadjusted models, there was an association between CE (versus non-CE) stroke subtype and LAA volume (OR per mL increase 1.15, 95% CI 1.07-1.24, P.001) and LAA density (4th quartile versus 1st quartile; OR 2.95, 95% CI 1.28-6.80, P = .011), but not with ESUS (versus non-CE) subtype. In adjusted models, only the association between LAA density and CE stroke subtype persisted (adjusted OR 3.71, 95% CI 1.37-10.08, P = .010).The LAA volume and density values on chest CT are associated with CE stroke subtype but not ESUS subtype. Patients with ESUS and increased LAA volume or attenuation may be a subgroup where the mechanism is CE and anticoagulation can be tested for secondary stroke prevention.
- Published
- 2020
47. FUNCTIONAL TRICUSPID REGURGITATION OUTCOMES AFTER INTERVENTION
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Athena Poppas and Kiersten Frenchu
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medicine.medical_specialty ,Heart disease ,business.industry ,medicine.disease ,Single Center ,humanities ,Functional tricuspid regurgitation ,Internal medicine ,Chart review ,cardiovascular system ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Surgical interventions - Abstract
Functional tricuspid regurgitation (FTR) is a maker increased mortality and is frequently associated with left-sided heart disease, RV failure and annulus dilation. However, FTR surgical interventions may not change patient outcomes. A single center, retrospective chart review of 32 patients who
- Published
- 2020
48. DOUBLE TROUBLE: CARDIOGENIC SHOCK SECONDARY TO SEVERE AORTIC VALVE INSUFFICIENCY ACROSS A BICUSPID VALVE AND SEVERE MITRAL VALVE REGURGITATION
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Kashif Ather, Athena Poppas, Daniel M. Levine, Neel R. Sodha, Sanchita Singal Parulkar, and Eirini Apostolidou
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medicine.medical_specialty ,Mitral regurgitation ,business.industry ,Cardiogenic shock ,macromolecular substances ,Regurgitation (circulation) ,Aortic Valve Insufficiency ,medicine.disease ,Bicuspid aortic valve ,Bicuspid valve ,Internal medicine ,Shock (circulatory) ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve regurgitation - Abstract
Bicuspid aortic valve (BAV) is a common congenital defect. This is a unique case of a patient with concomitant severe aortic regurgitation across a BAV and severe mitral regurgitation, presenting in shock. 55-year-old male with known BAV but no follow-up for 6 years, presented with two days of
- Published
- 2020
49. A DIFFICULT TO DIAGNOSE CASE OF EOSINOPHILIC MYOCARDITIS
- Author
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Hafiz Imran, Athena Poppas, and Kashif Ather
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Eosinophilic myocarditis - Published
- 2020
50. Brugada Syndrome
- Author
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Antony Chu, Athena Poppas, Kiersten Frenchu, Lauren Rousseau, and Shane Flood
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,electrocardiography ,Imaging Vignette ,medicine.disease ,sudden cardiac death ,Sudden cardiac death ,RC666-701 ,Internal medicine ,ECG Challenge ,Cardiology ,medicine ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,Brugada syndrome - Abstract
Rapid diagnosis of Brugada syndrome is critical to therapy, which is aimed at reversing provoking factors to suppress/terminate malignant arrhythmias.…, Rapid diagnosis of Brugada syndrome is critical to therapy, which is aimed at reversing provoking factors to suppress/terminate malignant arrhythmias. This case highlights the diagnosis and peri-operative management of patients with Brugada syndrome at high risk for sudden cardiac death. (Level of Difficulty: Beginner.), Graphical abstract
- Published
- 2019
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