39 results on '"Claire S. Duvernoy"'
Search Results
2. Women Representation Among Cardiology Journal Editorial Boards
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Sara Saberi, Sharlene M. Day, Sunkyung Yu, Claire S. Duvernoy, Prachi P. Agarwal, and Sowmya Balasubramanian
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Physicians, Women ,business.industry ,Physiology (medical) ,Cardiology ,Representation (systemics) ,Gender bias ,Humans ,Medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,Editorial Policies ,Linguistics - Published
- 2020
3. 10 Recommendations to Enhance Recruitment, Retention, and Career Advancement of Women Cardiologists
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Pamela S. Douglas, Amy Sarma, Toniya Singh, Claire S. Duvernoy, Sherry-Ann Brown, Inclusion Task Force, Sharonne N. Hayes, Sheila Sahni, Garima Sharma, Mary Norine Walsh, and Robert A. Harrington
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medicine.medical_specialty ,Career Choice ,business.industry ,030204 cardiovascular system & hematology ,Career Mobility ,Physicians, Women ,03 medical and health sciences ,Cardiologists ,0302 clinical medicine ,Family medicine ,medicine ,Humans ,Female ,030212 general & internal medicine ,Personnel Selection ,Cardiology and Cardiovascular Medicine ,Medical science ,business - Abstract
Regardless of the cause, the failure of cardiology to attract women when the gender ratio of medical undergraduates is approximately balanced indicates that a substantial proportion of the talent pool is being lost to other specialties. If this is not corrected, it will prove increasingly difficult
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- 2019
4. Gender Differences in the Pursuit of Cardiac Electrophysiology Training in North America
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Sena Killic, Marie Noelle Langan, Nashwa Abdulsalam, Anne K. Rzeszut, Edward O'Leary, Poonam Velagapudi, Kristin West, Claire S. Duvernoy, Celina M. Yong, and Anne M. Gillis
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Male ,medicine.medical_specialty ,Canada ,genetic structures ,media_common.quotation_subject ,Culture ,Cardiology ,Gender Role ,Physicians, Women ,Sex Factors ,Occupational Exposure ,Surveys and Questionnaires ,medicine ,Humans ,media_common ,Career Choice ,Cardiac electrophysiology ,business.industry ,Radiation Exposure ,United States ,Family medicine ,Female ,Cardiac Electrophysiology ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac ,Diversity (politics) - Abstract
Despite the increase in the number of female physicians across most specialties within cardiology, 10% of clinical cardiac electrophysiology (EP) fellows are women.This study sought to determine the factors that influence fellows-in-training (FITs) to pursue EP as a career choice and whether this differs by gender.The authors conducted an online multiple-choice survey through the American College of Cardiology to assess the decision factors that influence FITs in the United States and Canada to pursue cardiovascular subspecialties.A total of 933 (30.5%) FITs completed the survey; 129 anticipated specializing in EP, 259 in interventional cardiology (IC), and 545 in a different field or were unsure. A total of 1 in 7 (14%) FITs indicated an interest in EP. Of this group, more men chose EP than women (84% vs 16%; P 0.001). The most important factor that influenced FITs to pursue EP was a strong interest in the field. Women were more likely to be influenced by having a female role model (P = 0.001) compared with men. After excluding FITs interested in IC, women who deselected EP were more likely than men to be influenced by greater interest in another field (P = 0.004), radiation concerns (P = 0.001), lack of female role models (P = 0.001), a perceived "old boys' club" culture (P = 0.001) and discrimination/harassment concerns (P = 0.001).Women are more likely than men to be negatively influenced by many factors when it comes to pursuing EP as a career choice. Addressing those factors will help decrease the gender disparity in the field.
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- 2021
5. Effects of Home-Based Cardiac Rehabilitation on Time to Enrollment and Functional Status in Patients With Ischemic Heart Disease
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Mark Pabst, Daniel E. Forman, Hui Shen, David W. Schopfer, Claire S. Duvernoy, Mary A. Whooley, Gary Tarasovsky, and Kelly Allsup
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Male ,Telemedicine ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Myocardial Ischemia ,Disease ,030204 cardiovascular system & hematology ,outcomes ,03 medical and health sciences ,0302 clinical medicine ,Activities of Daily Living ,medicine ,Secondary Prevention ,Humans ,In patient ,030212 general & internal medicine ,Patient participation ,Aged ,Original Research ,Rehabilitation ,Cardiac Rehabilitation ,Exercise Tolerance ,exercise ,business.industry ,Home based ,Home Care Services ,Treatment Outcome ,Physical therapy ,Functional status ,Female ,telemedicine ,Cardiology and Cardiovascular Medicine ,Ischemic heart ,business ,Health Services and Outcomes Research - Abstract
Background Cardiac rehabilitation is an established performance measure for adults with ischemic heart disease, but patient participation is remarkably low. Home‐based cardiac rehabilitation (HBCR) may be more practical and feasible, but evidence regarding its efficacy is limited. We sought to compare the effects of HBCR versus facility‐based cardiac rehabilitation (FBCR) on functional status in patients with ischemic heart disease. Methods and Results This was a pragmatic trial of 237 selected patients with a recent ischemic heart disease event, who enrolled in HBCR or FBCR between August 2015 and September 2017. The primary outcome was 3‐month change in distance completed on a 6‐minute walk test. Secondary outcomes included rehospitalization as well as patient‐reported physical activity, quality of life, and self‐efficacy. Characteristics of the 116 patients enrolled in FBCR and 121 enrolled in HBCR were similar, except the mean time from index event to enrollment was shorter for HBCR (25 versus 77 days; P P P Conclusions Patients enrolled in HBCR achieved greater 3‐month functional gains than those enrolled in FBCR. Our data suggest that HBCR may safely derive equivalent benefits in exercise capacity and overall program efficacy in selected patients. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02105246.
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- 2020
6. Perceptions on Diversity in Cardiology: A Survey of Cardiology Fellowship Training Program Directors
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Anna Lisa Crowley, Chittur A. Sivaram, Claire S. Duvernoy, Sandra J. Lewis, James A. Arrighi, Robert A. Hong, Dorothy Jackson, Melanie S. Sulistio, Quinn Capers, Julie B. Damp, Andrew M. Kates, Donna M. Polk, Gaby Weissman, and Kathryn Berlacher
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Male ,medicine.medical_specialty ,media_common.quotation_subject ,Cardiology ,030204 cardiovascular system & hematology ,implicit bias ,Education ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Perception ,Physicians ,Surveys and Questionnaires ,diversity in cardiology ,medicine ,Humans ,030212 general & internal medicine ,Health Workforce ,Fellowships and Scholarships ,Healthcare Disparities ,Fellowship training ,media_common ,Original Research ,disparities ,business.industry ,Program director ,Cultural Diversity ,Education, Medical, Graduate ,Ethics and Policy ,Physician workforce ,Female ,Clinical Competence ,Implicit bias ,Cardiology and Cardiovascular Medicine ,business ,Prejudice ,training program directors ,Diversity (politics) ,Health Services and Outcomes Research - Abstract
Background The lack of diversity in the cardiovascular physician workforce is thought to be an important driver of racial and sex disparities in cardiac care. Cardiology fellowship program directors play a critical role in shaping the cardiology workforce. Methods and Results To assess program directors’ perceptions about diversity and barriers to enhancing diversity, the authors conducted a survey of 513 fellowship program directors or associate directors from 193 unique adult cardiology fellowship training programs. The response rate was 21% of all individuals (110/513) representing 57% of US general adult cardiology training programs (110/193). While 69% of respondents endorsed the belief that diversity is a driver of excellence in health care, only 26% could quote 1 to 2 references to support this statement. Sixty‐three percent of respondents agreed that “our program is diverse already so diversity does not need to be increased.” Only 6% of respondents listed diversity as a top 3 priority when creating the cardiovascular fellowship rank list. Conclusions These findings suggest that while program directors generally believe that diversity enhances quality, they are less familiar with the literature that supports that contention and they may not share a unified definition of "diversity." This may result in diversity enhancement having a low priority. The authors propose several strategies to engage fellowship training program directors in efforts to diversify cardiology fellowship training programs.
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- 2020
7. The Accreditation Council for Graduate Medical Education Mandates That You Attempt to Enhance Diversity in Your Cardiology Program: Great! (How Do We Do That?)
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Claire S. Duvernoy and Quinn Capers
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Gender Equity ,Male ,media_common.quotation_subject ,Sexism ,Graduate medical education ,MEDLINE ,Cardiology ,Accreditation ,Physicians, Women ,Cardiologists ,Racism ,Cultural diversity ,Medicine ,Humans ,media_common ,Medical education ,Career Choice ,business.industry ,Mentors ,Internship and Residency ,Cultural Diversity ,Race Factors ,Education, Medical, Continuing ,Female ,Curriculum ,Cardiology and Cardiovascular Medicine ,business ,Diversity (politics) - Published
- 2020
8. Sex Differences in Veterans' Cardiovascular Health
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Susan M. Frayne, Sally G. Haskell, Alison M. Whitehead, Nancy H Maher, Melinda B. Davis, Karen M. Goldstein, Claire S. Duvernoy, Fay Saechao, Jimmy Lee, Basmah Safdar, and Bevanne Bean-Mayberry
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Gerontology ,Adult ,Male ,genetic structures ,Adolescent ,Cardiovascular health ,Veterans Health ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Veterans ,Sex Characteristics ,business.industry ,Depression ,General Medicine ,Middle Aged ,Civilian population ,humanities ,United States ,United States Department of Veterans Affairs ,Cardiovascular Diseases ,Female ,business - Abstract
Background: In the U.S. civilian population, sex differences have been identified in cardiovascular health; these differences have been used to inform care. Our objective is to determine i...
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- 2019
9. 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
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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
10. Left ventricular metabolism, function, and sympathetic innervation in men and women with type 1 diabetes
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Jadranka Stojanovska, Scott D. Swanson, Morton B. Brown, Subramaniam Pennathur, Cynthia Plunkett, Mamta Jaiswal, Gisela C. Mueller, Claire S. Duvernoy, David M. Raffel, El-Sayed H. Ibrahim, and Rodica Pop-Busui
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Adult ,Male ,medicine.medical_specialty ,Sympathetic Nervous System ,Diabetic Cardiomyopathies ,Heart Ventricles ,Sympathetic nerve ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Coronary Circulation ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ephedrine ,Sex Characteristics ,Type 1 diabetes ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Stroke Volume ,Blood flow ,Metabolism ,medicine.disease ,Diabetes Mellitus, Type 1 ,Endocrinology ,Positron emission tomography ,Cardiology ,Female ,Sympathetic innervation ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Abstract
In type I diabetes (T1DM), alterations in LV function may occur due to changes in innervation, metabolism, and efficiency.We evaluated the association between sympathetic nerve function, oxidative metabolism, resting blood flow, LV efficiency and function in healthy diabetics, and assessed gender differences.Cross-sectional study of 45 subjects with T1DM, 60% females, age 34 ± 13 years, and 10 age-matched controls. Positron emission tomography (PET) imaging with [(11)C]acetate and [(11)C]meta-hydroxyephedrine was performed, in addition to cardiac magnetic resonance imaging.There were no significant differences in LV function, innervation, or oxidative metabolism between T1DM and controls. Cardiac oxidative metabolism was positively associated with higher levels of sympathetic activation, particularly in women. Diabetic women had significantly lower efficiency compared with diabetic men. Resting flow was significantly higher in diabetic women compared with diabetic men, and tended to be higher in female controls as well.Measures of myocardial function, metabolism, blood flow, and sympathetic activation were preserved in young, otherwise healthy, T1DM patients. However, T1DM women presented with greater myocardial oxidative metabolism requirements than men. Ongoing studies are evaluating changes over time.
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- 2016
11. Sex Differences in the Pursuit of Interventional Cardiology as a Subspecialty Among Cardiovascular Fellows-in-Training
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Cindy L. Grines, Interventions Women in Innovations, Roxana Mehran, Pamela S. Douglas, Celina M. Yong, Freddy Abnousi, Anne K. Rzeszut, S. Elissa Altin, Claire S. Duvernoy, and Robert A. Harrington
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Adult ,Male ,medicine.medical_specialty ,Attitude of Health Personnel ,Cardiology ,030204 cardiovascular system & hematology ,Subspecialty ,Choice Behavior ,03 medical and health sciences ,Physicians, Women ,0302 clinical medicine ,Cardiologists ,Sex Factors ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Interventional cardiology ,Career Choice ,business.industry ,Odds ratio ,Confidence interval ,Education, Medical, Graduate ,Family medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,Specialization - Abstract
The authors sought to determine the factors that influence fellows-in-training (FITs) to pursue a career in interventional cardiology (IC) and how these differ by sex.Despite increases in the proportion of women across numerous medical and surgical specialties over the last decade, IC still ranks at the bottom in terms of representation of women. It is unclear why this maldistribution persists.An online survey of cardiovascular FITs was conducted under the direction of the American College of Cardiology Women in Cardiology Leadership Council to assess FIT perspectives regarding subspecialty choices.Of 574 respondents, 33% anticipated specializing in IC. Men were more likely to choose IC than women (39% men, 17% women, odds ratio: 3.98 [95% confidence interval: 2.38 to 6.68]; p 0.001). Men were more likely to be married (p = 0.005) and have children (p = 0.002). Among married FITs, male IC FITs were more likely to have spouses who do not work (p = 0.003). Although men were more likely to be influenced by positive attributes to pursue IC, women were significantly more likely to be influenced negatively against pursuing the field by attributes including greater interest in another field (p = 0.001), little job flexibility (p = 0.02), physically demanding nature of job (p = 0.004), radiation during childbearing (p 0.001), "old boys' club" culture (p 0.001), lack of female role models (p 0.001), and sex discrimination (p 0.001).Many factors uniquely dissuade women from pursuing IC compared with men, largely related to the culture of IC as a subspecialty. Targeted resolution of these specific factors may provide the most impact in reducing sex imbalances in the field.
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- 2018
12. Career Preferences and Perceptions of Cardiology Among US Internal Medicine Trainees: Factors Influencing Cardiology Career Choice
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Pamela S. Douglas, Mary Norine Walsh, Linda D. Gillam, C. Noel Bairey Merz, Claire S. Duvernoy, Sandra J. Lewis, and Anne K. Rzeszut
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Attractiveness ,Adult ,Male ,medicine.medical_specialty ,Attitude of Health Personnel ,education ,MEDLINE ,Cardiology ,Organizational culture ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Physicians, Women ,0302 clinical medicine ,Internal medicine ,Surveys and Questionnaires ,medicine ,Internal Medicine ,Humans ,030212 general & internal medicine ,Career Choice ,business.industry ,Professional development ,Work–life balance ,Work-Life Balance ,Organizational Culture ,Family life ,Workforce ,Female ,Cardiology and Cardiovascular Medicine ,business ,Diversity (business) - Abstract
Importance Few data exist on internal medicine trainees’ selection of cardiology training, although this is important for meeting future cardiology workforce needs. Objective To discover trainees’ professional development preferences and perceptions of cardiology, and their relationship to trainees’ career choice. Design, Setting, and Participants We surveyed trainees to discover their professional development preferences and perceptions of cardiology and the influence of those perceptions and preferences on the trainees’ career choices. Participants rated 38 professional development needs and 19 perceptions of cardiology. Data collection took place from February 2009, through January 2010. Data analysis was conducted from May 2017 to December 2017. Main Outcomes and Measures Multivariable models were used to determine the association of demographics and survey responses with prospective career choice. Results A total of 4850 trainees were contacted, and 1123 trainees (of whom 625 [55.7%] were men) in 198 residency programs completed surveys (23.1% response; mean [SD] age, 29.4 [3.5] years). Principal component analysis of survey responses resulted in 8-factor and 6-factor models. Professional development preferences in descending order of significance were stable hours, family friendliness, female friendliness, the availability of positive role models, financial benefits, professional challenges, patient focus, and the opportunity to have a stimulating career. The top perceptions of cardiology in descending order of significance were adverse job conditions, interference with family life, and a lack of diversity. Women and future noncardiologists valued work-life balance more highly and had more negative perceptions of cardiology than men or future cardiologists, who emphasized the professional advantages available in cardiology. Professional development factors and cardiology perceptions were strongly associated with a decision to pursue or avoid a career in cardiology in both men and women. Conclusions and Relevance Alignment of cardiology culture with trainees’ preferences and perceptions may assist efforts to ensure the continued attractiveness of cardiology careers and increase the diversity of the cardiology workforce.
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- 2018
13. Treatment of Coronary Artery Disease in Women
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Emily Perdoncin and Claire S. Duvernoy
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Male ,medicine.medical_specialty ,Reviews ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Healthcare Disparities ,Evidence-Based Medicine ,business.industry ,Disease mortality ,Microvascular angina ,General Medicine ,Health Status Disparities ,medicine.disease ,Pathophysiology ,Patient population ,Treatment Outcome ,Cardiology ,Female ,business ,Ischemic heart - Abstract
Despite advances in the diagnosis and treatment of coronary artery disease (CAD), gender-related disparities continue to exist, and ischemic heart disease mortality in women remains higher than in men. This review will highlight gender-specific differences in the treatment of CAD that may impact outcomes for women. Further studies are needed to clarify the unique pathophysiology of CAD in women and, in turn, create more specific guidelines for its diagnosis, management, and treatment in this patient population.
- Published
- 2018
14. Regional cardiac function analysis from tagged MRI images. Comparison of techniques: Harmonic-Phase (HARP) versus Sinusoidal-Modeling (SinMod) analysis
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Azza S. Hassanein, Jadranka Stojanovska, Rodica Pop-Busui, Scott D. Swanson, El-Sayed H. Ibrahim, Claire S. Duvernoy, Pierre Croisille, RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne)
- Subjects
Cardiac function curve ,Adult ,Male ,[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging ,Systole ,[SDV]Life Sciences [q-bio] ,Heart Ventricles ,Biomedical Engineering ,Biophysics ,030204 cardiovascular system & hematology ,Harmonic phase ,Imaging phantom ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Mri image ,Young Adult ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Diastole ,Image Processing, Computer-Assisted ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,ComputingMilieux_MISCELLANEOUS ,HARP ,Observer Variation ,business.industry ,Phantoms, Imaging ,Myocardium ,Reproducibility of Results ,Heart ,Magnetic Resonance Imaging ,Myocardial Contraction ,Global strain ,Diabetes Mellitus, Type 1 ,Myocardial strain ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Female ,business ,Nuclear medicine ,Algorithms - Abstract
Cardiac MRI tagging is a valuable technique for evaluating regional heart function. Currently, there are a number of different techniques for analyzing the tagged images. Specifically, k-space-based analysis techniques showed to be much faster than image-based techniques, where harmonic-phase (HARP) and sine-wave modeling (SinMod) stand as two famous techniques of the former group, which are frequently used in clinical studies. In this study, we compared HARP and SinMod and studied inter-observer variability between the two techniques for evaluating myocardial strain and apical-to-base torsion in numerical phantom, nine healthy controls, and thirty diabetic patients. Based on the ground-truth numerical phantom measurements (strain = −20% and rotation angle = −4.4°), HARP and SinMod resulted in overestimation (in absolute value terms) of strain by 1% and 5% (strain values), and of rotation angle by 0.4° and 2.0°, respectively. For the in-vivo results, global strain and torsion ranges were −10.6% to −35.3% and 1.8°/cm to 12.7°/cm in patients, and −17.8% to −32.7% and 1.8°/cm to 12.3°/cm in volunteers. On average, SinMod overestimated strain measurements by 5.7% and 5.9% (strain values) in the patients and volunteers, respectively, compared to HARP, and overestimated torsion measurements by 2.9°/cm and 2.5°/cm in the patients and volunteers, respectively, compared to HARP. Location-wise, the ranges for basal, mid-ventricular, and apical strain in patients (volunteers) were −8.4% to −31.5% (−11.6% to −33.3%), −6.3% to −37.2% (−17.8% to −33.3%), and −5.2% to −38.4% (−20.0% to −33.2%), respectively. SinMod overestimated strain in the basal, mid-ventricular, and apical slices by 4.7% (5.7%), 5.9% (5.5%), and 8.9% (6.8%), respectively, compared to HARP in the patients (volunteers). Nevertheless, there existed good correlation between the HARP and SinMod measurements. Finally, there were no significant strain or torsion measurement differences between patients and volunteers. There existed good inter-observer agreement, as all measurement differences lied within the Bland-Altman ± 2 standard-deviation (SD) difference limits. In conclusion, despite the consistency of the results by either HARP or SinMod and acceptable agreement of the generated strain and torsion patterns by both techniques, SinMod systematically overestimated the measurements compared to HARP. Under current operating conditions, the measurements from HARP and SinMod cannot be used interchangeably.
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- 2017
15. Peripartum Cardiomyopathy: Current Knowledge and Future Directions
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Melinda B. Davis and Claire S. Duvernoy
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medicine.medical_specialty ,Peripartum cardiomyopathy ,Pregnancy Complications, Cardiovascular ,Multiple Birth Offspring ,Pregnancy ,Risk Factors ,Internal medicine ,Natriuretic Peptide, Brain ,Peripartum Period ,medicine ,Humans ,business.industry ,Age Factors ,Cardiovascular Agents ,General Medicine ,Prognosis ,medicine.disease ,United States ,Black or African American ,Breast Feeding ,Echocardiography ,Heart failure ,Hypertension ,Cardiovascular agent ,Etiology ,Cardiology ,Female ,Cardiomyopathies ,business ,Breast feeding ,Postpartum period - Abstract
Peripartum cardiomyopathy is a form of heart failure occurring at the end of pregnancy or early in the postpartum period. Women may recover, have persistent cardiac dysfunction or suffer complications and death. Women who are African-American, older, hypertensive or have multiple gestation pregnancies have increased risk. Diagnosis and treatment may be delayed due to similarities between symptoms of normal pregnancy and heart failure. Echocardiography is essential for the diagnosis, and B-type natriuretic peptide can be helpful. Treatment for systolic heart failure must be adjusted during pregnancy, and anticoagulation may be indicated. Even after recovery, subsequent pregnancy confers substantial risk of worsening heart failure. Further investigations into the etiology, duration of treatment and risks for relapse are needed.
- Published
- 2015
16. Acute Coronary Syndromes: Differences in Men and Women
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Kris Kawamoto, Claire S. Duvernoy, and Melinda B. Davis
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Myocardial Infarction ,Disease ,Comorbidity ,030204 cardiovascular system & hematology ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Diabetes Mellitus ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Intensive care medicine ,Angiology ,Sex Characteristics ,business.industry ,medicine.disease ,Pathophysiology ,Cardiology ,Female ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Increased awareness of cardiovascular disease in women has prompted studies to investigate gender-related disparities in acute coronary syndromes (ACSs). In this review, we discuss findings from current literature on the clinical presentation, pathophysiology, diagnosis, and management of ACS in women as compared to men.Emerging data show that cardiovascular disease (CVD) continues to be the leading cause of death in women and the annual mortality rate from CVD remains higher in women compared to men. Recent studies demonstrate sex-specific differences in patients presenting with ACS. Comorbidities, especially diabetes, are more common in young women compared with age-matched men who develop acute myocardial infarction (AMI). Women are more likely to have atypical symptoms and nonobstructive coronary disease on angiography. Women are less likely to receive guideline-based therapies. They have higher rates of peri-procedural complications with PCI and are less likely to be referred to cardiac rehabilitation. Awareness of differences in the underlying pathophysiology of coronary disease in women compared to men may lead to improved gender-based diagnostic and treatment modalities. However, until more studies are performed, efforts should be directed toward improving delivery of current, gender-neutral guidelines in women just as in men.
- Published
- 2016
17. Evolving strategies for the treatment of microvascular angina in women
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Claire S. Duvernoy
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medicine.medical_specialty ,Statin ,medicine.drug_class ,Adrenergic beta-Antagonists ,Ranolazine ,Angiotensin-Converting Enzyme Inhibitors ,Chest pain ,Muscle, Smooth, Vascular ,Pharmacotherapy ,Risk Factors ,Coronary Circulation ,Cardiac syndrome X ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Risk factor ,Exercise ,Microvascular Angina ,medicine.diagnostic_test ,business.industry ,Coronary flow reserve ,General Medicine ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Microvessels ,Angiography ,Cardiology ,Women's Health ,Drug Therapy, Combination ,Female ,Endothelium, Vascular ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Microvascular angina, also known as cardiac syndrome X, is characterized by anginal chest pain, at least one cardiovascular risk factor, an abnormal stress test and normal coronary arteries on angiography. It is significantly more common in women than in men. A definitive diagnosis of microvascular angina can be made by invasive or noninvasive methods; a presumptive diagnosis can also be made based on fulfillment of diagnostic criteria. Effective treatment of microvascular angina requires aggressive risk factor modification; exercise is one of the most effective treatment modalities. Several other treatment strategies have been shown to relieve anginal symptoms as well as improve vascular function; these include β-blockers, angiotensin-converting enzyme inhibitors, ranolazine, L-arginine, statin drugs and potentially estrogen replacement therapy. Nitrates may be effective for symptom relief. Further studies are required to determine whether specific treatments are associated with improved survival as well as decreased symptoms.
- Published
- 2012
18. Cardiovascular Medicine and Society: The Pregnant Cardiologist
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Amy A, Sarma, Chileshe, Nkonde-Price, Martha, Gulati, Claire S, Duvernoy, Sandra J, Lewis, and Malissa J, Wood
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Physicians, Women ,Cardiologists ,Career Choice ,Pregnancy ,Cardiology ,Workforce ,Humans ,Female ,Job Satisfaction ,Societies, Medical ,United States - Abstract
Women are a consistent minority in the field of cardiology, with concerns regarding balancing career and parenting responsibilities often cited as a contributing factor to this under-representation. To investigate the impact that a career in cardiology may have on the family planning decisions of female cardiologists, the Women in Cardiology section of the American College of Cardiology conducted a voluntary anonymous survey. The following perspective highlights lessons learned from the survey, and potential solutions to the issues surrounding maternity leave, radiation exposure during pregnancy, and breastfeeding accommodations raised by these data. Given that most female cardiologists are pregnant at some point during their careers, particularly during the vulnerable periods of training and early career, improving the experience of pregnancy and early parenthood for all cardiologists may secure the best possible candidates to the field of cardiology.
- Published
- 2016
19. Changes in the Professional Lives of Cardiologists Over 2 Decades
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Anne K. Rzeszut, Pamela S. Douglas, Athena Poppas, Marian C. Limacher, Mary Norine Walsh, Laxmi S. Mehta, Martha Gulati, Claire S. Duvernoy, and Sandra J. Lewis
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Adult ,Male ,medicine.medical_specialty ,Sexism ,Cardiology ,Personal life ,030204 cardiovascular system & hematology ,Subspecialty ,Job Satisfaction ,03 medical and health sciences ,0302 clinical medicine ,Professional life ,Surveys and Questionnaires ,Medicine ,Humans ,Family ,030212 general & internal medicine ,Aged ,Response rate (survey) ,business.industry ,Mentoring ,Professional Practice ,Middle Aged ,Career satisfaction ,United States ,Aging in the American workforce ,Private practice ,Family medicine ,Workforce ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The American College of Cardiology third decennial Professional Life Survey was completed by 2,313 cardiologists: 964 women (42%) and 1,349 men (58%). Compared with 10 and 20 years ago, current results reflect a substantially lower response rate (21% vs. 31% and 49%, respectively) and an aging workforce that is less likely to be in private practice. Women continue to be more likely to practice in academic centers, be pediatric cardiologists, and have a noninvasive subspecialty. Men were more likely to indicate that family responsibilities negatively influenced their careers than previously, whereas women remained less likely to marry or have children. Men and women reported similar, high levels of career satisfaction, with women reporting higher satisfaction currently. However, two-thirds of women continue to experience discrimination, nearly 3 times the rate in men. Personal life choices continue to differ substantially for men and women in cardiology, although differences have diminished.
- Published
- 2016
20. How to Stay Heart Healthy in 2011: Considerations for the Primary Prevention of Cardiovascular Disease in Women
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Claire S. Duvernoy and Melinda B Davis
- Subjects
medicine.medical_specialty ,Health Status ,Disease ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Health Education ,Life Style ,Societies, Medical ,Pregnancy ,Aspirin ,Framingham Risk Score ,business.industry ,General Medicine ,medicine.disease ,Obesity ,United States ,Primary Prevention ,Gestational diabetes ,Women's Health Services ,Blood pressure ,Cardiovascular Diseases ,Practice Guidelines as Topic ,Physical therapy ,Female ,business ,medicine.drug - Abstract
More women die of cardiovascular disease than any other cause. Effective primary prevention depends on accurate assessment of risk status. While most risk factors are similar for men and women, risk factors may differ in magnitude between the sexes, and recognition of gender-specific risk factors such as gestational diabetes, hypertensive syndromes of pregnancy and polycystic ovarian syndrome provides opportunities for early intervention and prevention. Obesity, hypertension and hyperlipidemia affect both genders; however, women often postpone addressing these risk factors until later in life. The American Heart Association emphasizes that all women are at cardiovascular risk and should maintain a healthy lifestyle and avoid smoking. Blood pressure, hyperlipidemia and diabetes should be aggressively treated. Current available data regarding proposed preventive drug therapies including daily aspirin, HRT, vitamin D and omega-3 fatty acid supplements will be reviewed.
- Published
- 2011
21. Antiplatelet Therapy Use and the Risk of Venous Thromboembolic Events in the Raloxifene Use for the Heart (RUTH) Trial
- Author
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Claire S. Duvernoy, Hyungjin M. Kim, Mayme Wong, David A. Cox, and Adeline A. Yeo
- Subjects
Selective Estrogen Receptor Modulators ,medicine.medical_specialty ,Coronary Disease ,Cohort Studies ,Placebos ,Double-Blind Method ,Risk Factors ,Internal medicine ,medicine ,Humans ,Raloxifene ,cardiovascular diseases ,Platelet activation ,Ticlopidine ,Proportional Hazards Models ,Aspirin ,business.industry ,Warfarin ,Venous Thromboembolism ,General Medicine ,Middle Aged ,Clopidogrel ,Postmenopause ,Dipyridamole ,Treatment Outcome ,Raloxifene Hydrochloride ,Anesthesia ,Female ,business ,Platelet Aggregation Inhibitors ,Cohort study ,medicine.drug - Abstract
Raloxifene use in postmenopausal women with osteoporosis increases the risk of venous thromboembolic events (VTE) 2-fold compared with placebo. Platelet activation is involved in the pathophysiology of arterial thromboses more than venous thromboses, but aspirin may reduce VTE risk associated with estrogen use. This analysis examines the effects of concomitant antiplatelet therapy on VTE risk in raloxifene-treated women.In the Raloxifene Use for the Heart (RUTH) trial, 10,101 postmenopausal women from 177 sites in 26 countries at increased risk of coronary heart disease (CHD) (primary prevention cohort) or with CHD (secondary prevention cohort) were randomized to placebo or raloxifene 60 mg/day and followed for a median 5.6 years. Reports of clinical symptoms of VTE were assessed. Concomitant use of antiplatelet agents (aspirin, clopidogrel, ticlopidine, dipyridamole) was allowed. Cox proportional hazard models, with use of warfarin, presence of fracture, and hospitalization as covariates, were used to estimate hazard ratios (HR) with 95% confidence intervals (CI).Overall, raloxifene use was associated with an increased VTE risk (HR 1.44, 95% CI 1.06-1.95) vs. placebo. Most women (72%) reported using aspirin, and 14.2% reported using nonaspirin antiplatelet agents during the study period. Users of antiplatelet agents were older, more likely to have CHD, and more likely to be hyperlipidemic. They had a higher VTE risk than nonusers. No difference in VTE risk was observed in women who used raloxifene alone vs. those who used raloxifene with antiplatelet agents during the study. The increase in VTE risk with raloxifene compared with placebo was not different between women who used antiplatelet agents at baseline (HR 1.44, 95% CI 0.98, 2.10) and those who did not use antiplatelet agents (HR 1.37, 95% CI 0.83, 2.27) (interaction p = 0.88). Similar conclusions were noted for aspirin and nonaspirin antiplatelet use.In RUTH, postmenopausal women treated with raloxifene had an increased risk of VTE compared with placebo. Concomitant use of aspirin or nonaspirin antiplatelet agents along with raloxifene did not change VTE risk.
- Published
- 2010
22. Association of Veterans Health Administration Home-Based Programs With Access to and Participation in Cardiac Rehabilitation
- Author
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Nirupama Krishnamurthi, Daniel E. Forman, Mary A. Whooley, Hui Shen, Claire S. Duvernoy, and David W. Schopfer
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Veterans Health ,030204 cardiovascular system & hematology ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,health care economics and organizations ,Aged ,Cardiac Rehabilitation ,Rehabilitation ,Extramural ,business.industry ,Middle Aged ,Veterans health ,Home Care Services ,Home based ,United States ,humanities ,United States Department of Veterans Affairs ,Family medicine ,cardiovascular system ,Female ,business ,Administration (government) - Abstract
This study examines whether implementing new home-based cardiac rehabilitation programs is associated with cardiac rehabilitation participation in the Veterans Health Administration.
- Published
- 2018
23. RISK OF OBSTRUCTIVE CORONARY ARTERY DISEASE AND MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS WITH NON-CORONARY ATHEROSCLEROSIS: INSIGHTS FROM THE VETERANS AFFAIRS CLINICAL ASSESSMENT, REPORTING AND TRACKING (CART) PROGRAM
- Author
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Kevin Josey, Thomas M. Maddox, Deepak L. Bhatt, Claire S. Duvernoy, Rajesh V. Swaminathan, Thomas J. Glorioso, Subhash Banerjee, Sunil V. Rao, Ehrin J. Armstrong, J. Antonio Gutierrez, and Stephen W. Waldo
- Subjects
Male ,Risk ,Cart ,Coronary angiography ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Coronary artery disease ,Peripheral Arterial Disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,Prevalence ,Humans ,Medicine ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Veterans Affairs ,Coronary atherosclerosis ,Aged ,medicine.diagnostic_test ,business.industry ,Coronary Stenosis ,Percutaneous coronary intervention ,Middle Aged ,Atherosclerosis ,medicine.disease ,United States ,Stenosis ,Veterans Health Services ,Conventional PCI ,Angiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background We sought to determine the risk of obstructive coronary artery disease (oCAD) associated with noncoronary atherosclerosis (cerebrovascular disease [CVD] or peripheral arterial disease [PAD]) and major adverse cardiac events following percutaneous coronary intervention (PCI). Methods Rates of the angiographic end point of oCAD were compared among patients with and without noncoronary atherosclerosis undergoing coronary angiography within the Veterans Health Administration between October 2007 and August 2015. The primary angiographic end point of oCAD was defined as left main stenosis ≥50% or any stenosis ≥70% in 1, 2, or 3 vessels. In patients who proceeded to PCI, the rate of the composite clinical end point of death, myocardial infarction, or stroke was compared among those with concomitant noncoronary atherosclerosis (CVD, PAD, or CVD + PAD) versus isolated CAD. Results Among 233,353 patients undergoing angiography, 9.6% had CVD, 12.4% had PAD, and 6.1% had CVD + PAD. Rates of oCAD were 57.9% for neither CVD nor PAD, 66.4% for CVD, 73.6% for PAD, and 80.9% for CVD + PAD. Compared with patients without noncoronary atherosclerosis, the adjusted risk of oCAD with CVD, PAD, or CVD + PAD was 1.03 (95% CI 1.02-1.04), 1.10 (95% CI 1.09-1.11), and 1.12 (95% CI 1.11-1.13), respectively. In patients who underwent PCI, the adjusted hazard for death, myocardial infarction, or stroke among those with CVD, PAD, or CVD + PAD was 1.36 (95% CI 1.26-1.45), 1.53 (95% CI 1.45-1.62), and 1.72 (95% CI 1.59-1.86), respectively. Conclusions In patients undergoing coronary angiography, noncoronary atherosclerosis was associated with increased burden of oCAD and adverse events post-PCI.
- Published
- 2018
24. Evaluation of Patients With Severe Symptomatic Aortic Stenosis Who Do Not Undergo Aortic Valve Replacement
- Author
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Benjamin D. McCallister, Derrick Siao, David S. Bach, Steven E. Girard, Sarah K. Gualano, and Claire S. Duvernoy
- Subjects
Adult ,Male ,Michigan ,medicine.medical_specialty ,Hospitals, Veterans ,medicine.medical_treatment ,Private Practice ,Comorbidity ,Risk Assessment ,Severity of Illness Index ,Hospitals, University ,Treatment Refusal ,Aortic valve replacement ,Valve replacement ,Severity of illness ,medicine ,Humans ,Referral and Consultation ,Veterans Affairs ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Age Factors ,Retrospective cohort study ,Aortic Valve Stenosis ,Guideline ,Middle Aged ,medicine.disease ,Surgery ,Private practice ,Aortic Valve ,Heart Valve Prosthesis ,Aortic valve stenosis ,Exercise Test ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background— Some patients with severe symptomatic aortic stenosis (AS) do not undergo aortic valve replacement (AVR) despite demonstrated symptomatic and survival advantages and despite unequivocal guideline recommendations for surgical evaluation. Methods and Results— In 3 large tertiary care institutions (university, Veterans Affairs, and private practice) in Washtenaw County, Mich, patients were identified with unrefuted echocardiography/Doppler evidence of severe AS during calendar year 2005. Medical records were retrospectively reviewed for symptoms, referral for AVR, calculated operative risk for AVR, and rationale as to why patients did not undergo valve replacement. Of 369 patients with severe AS, 191 (52%) did not undergo AVR. Of these, 126 (66%, 34% of total) had symptoms consistent with AS. The most common reasons cited for absent intervention were comorbidities with high operative risk (61 patients [48%]), patent refusal (24 patients [19%]), and symptoms unrelated to AS (24 patients [19%]). Operated patients had a lower Society of Thoracic Surgery–calculated perioperative mortality risk than unoperated patients (1.8% [interquartile range, 1.0 to 3.0%] versus 2.7% [interquartile range, 1.6 to 5.5%], P Conclusions— One third of patients with severe AS are symptomatic but do not undergo AVR, with similar findings in multiple practice environments. For most unoperated patients, objectively calculated operative risks did not appear prohibitive. Despite this, a minority of unoperated patients were referred for surgical consultation. Some patients with severe symptomatic AS may be inappropriately denied access to potentially life-saving therapy.
- Published
- 2009
25. Raloxifene use in clinical practice
- Author
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Steven R. Goldstein, John L. Mershon, Jonathan D. Adachi, Sherie A. Dowsett, Claire S. Duvernoy, D Agnusdei, Joaquim Calaf, and Cynthia A. Stuenkel
- Subjects
Selective Estrogen Receptor Modulators ,Oncology ,medicine.medical_specialty ,Osteoporosis ,Breast Neoplasms ,Fractures, Bone ,Breast cancer ,Risk Factors ,Internal medicine ,medicine ,Humans ,Raloxifene ,Adverse effect ,Stroke ,Gynecology ,business.industry ,Incidence (epidemiology) ,Obstetrics and Gynecology ,Cancer ,medicine.disease ,Clinical Practice ,Treatment Outcome ,Raloxifene Hydrochloride ,Female ,business ,medicine.drug - Abstract
Objective and Methods: In this article, we provide an interdisciplinary concise review of the effects of raloxifeneon breast, bone, and reproductive organs, as well as the adverse events that may be associated with its use.Results: Raloxifene has been shown to prevent osteoporosis in postmenopausal women (PMW) with low bonemass and prevent vertebral fractures in those with osteoporosis/low bone mass; it has not been shown to reduce therisk of nonvertebral fractures. Raloxifene reduces the risk of invasive breast cancer in PMW with osteoporosis or athigh risk of breast cancer. The risk of venous thromboembolism has been consistently shown to be increased withraloxifene, so it should not be used in women at high risk of venous thromboembolism. Although raloxifene doesnot increase, nor decrease, the risk of coronary or stroke events overall, in the raloxifene trial of PMW at increasedrisk of coronary events, the incidence of fatal stroke was higher in women assigned raloxifene versus placebo.Conclusions: Based on its approved indications, it is appropriate to prescribe raloxifene to prevent or treatosteoporosis, as well as to reduce the risk of invasive breast cancer in PMW with osteoporosis or at high risk ofbreast cancer. Women at increased risk of both fracture and invasive breast cancer are those most likely to receive adual benefit with raloxifene. Decision making must involve the incorporation of the woman’s personal feelingsabout the risks and benefits of raloxifene therapy, balanced with her interest in reducing risk of fractures and breastcancer through pharmacological intervention.Key Words: Raloxifene Y Invasive breast cancer Y Fracture Y Osteoporosis Y Safety.
- Published
- 2009
26. Cardiovascular risk, obesity, and myocardial blood flow in postmenopausal women
- Author
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Patricia A. Rose, Apurva A. Motivala, Robert D. Brook, Otto Muzik, Yolanda R. Smith, H. Myra Kim, Catherine Bartnik, and Claire S. Duvernoy
- Subjects
medicine.medical_specialty ,Homocysteine ,Population ,Hemodynamics ,Coronary Artery Disease ,Disease ,Overweight ,Risk Assessment ,chemistry.chemical_compound ,Risk Factors ,Internal medicine ,Prevalence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Obesity ,Radionuclide Imaging ,education ,Aged ,education.field_of_study ,business.industry ,Blood flow ,Middle Aged ,medicine.disease ,Postmenopause ,medicine.anatomical_structure ,chemistry ,Vascular resistance ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background. This study was designed to determine whether overweight or obese status is independently associated with myocardial flow reserve (MFR), an established predictor of cardiovascular mortality, in a group of postmenopausal women with no previous cardiovascular disease. Postmenopausal women are the largest group of overweight and physically inactive individuals in the United States. Increased body mass index (BMI) is consistently associated with increased cardiovascular mortality in this population. Whether this is because of obesity itself or the accompanying increase in cardiovascular risk factors (CRFs) remains controversial. Methods. We examined the relationship of myocardial blood flow (MBF), coronary vascular resistance, and MFR to BMI in 60 postmenopausal women with no coronary heart disease. Subjects underwent dynamic N-13 ammonia positron emission tomography for the measurement of MBF and MFR. Baseline demographics, CRF, and hemodynamic parameters were recorded for each subject. Datasets were divided into 3 groups according to BMI: normal (18 to 24), overweight (25 to 29), and obese (≥30). Results. The overweight and obese groups showed significantly higher resting MBF and lower MFR than the normal-weight group (both P
- Published
- 2008
27. Combined Continuous Ethinyl Estradiol/Norethindrone Acetate Does Not Improve Forearm Blood Flow in Postmenopausal Women at Risk for Cardiovascular Events: A Pilot Study
- Author
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Robert D. Brook, Christine Kehrer, Claire S. Duvernoy, Patricia A. Rose, and H. Myra Kim
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Vascular Cell Adhesion Molecule-1 ,Physiology ,Pilot Projects ,Ethinyl Estradiol ,Drug Administration Schedule ,law.invention ,chemistry.chemical_compound ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,Plasminogen Activator Inhibitor 1 ,parasitic diseases ,medicine ,Humans ,Aged ,Ethinyl Estradiol/Norethindrone ,Cross-Over Studies ,Postmenopausal women ,Endothelin-1 ,business.industry ,Cholesterol ,Cholesterol, HDL ,Estrogen Replacement Therapy ,Cholesterol, LDL ,General Medicine ,Norethindrone Acetate ,Middle Aged ,Crossover study ,Postmenopause ,Forearm ,C-Reactive Protein ,Treatment Outcome ,Endocrinology ,chemistry ,Cardiovascular Diseases ,Regional Blood Flow ,Forearm blood flow ,Women's Health ,Female ,Hormone therapy ,Norethindrone ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
This study sought to determine whether combined continuous ethinyl estradiol and norethindrone acetate, a postmenopausal hormone therapy (HT) combination designed to have fewer side effects than cyclical therapies and therapies using medroxyprogesterone acetate (MPA), could improve vascular endothelial function in postmenopausal women with risk factors for cardiovascular disease (CVD).Eighteen postmenopausal women (mean age 62 +/- 11 years) participated in a randomized, placebo-controlled, crossover design trial of 10 microg estradiol/1 mg norethindrone acetate given once daily for 3 months, with a 1-month washout period between placebo and active treatment phases. Vascular reactivity was assessed at each phase of the study using high-frequency brachial artery ultrasound in response to flow-mediated hyperemia, cold pressor testing, and sublingual nitroglycerin. Markers of cardiovascular risk, including cholesterol levels, inflammatory markers, fibrinolytic markers, and solubilized adhesion molecules, were also measured at each phase.We found no significant difference in vascular reactivity measurements during active treatment with ethinyl estradiol/norethindrone acetate vs. placebo. C-reactive protein (CRP) levels increased significantly during active treatment, and high-density lipoprotein (HDL) levels decreased significantly. Vascular cell adhesion molecule-1 (VCAM-1) levels declined during active treatment. Plasminogen activator inhibitor-1 (PAI-1) levels were inversely correlated with flow-mediated hyperemic vascular reactivity, independent of active treatment or placebo phases.In this older postmenopausal population with at least one cardiovascular risk factor, treatment with combined continuous ethinyl estradiol and norethindrone acetate failed to improve vascular endothelial function. The agent's proinflammatory effect or subclinical atherosclerosis in this population may have contributed to this finding.
- Published
- 2007
28. Characteristics and outcomes of women veterans undergoing cardiac catheterization in the Veterans Affairs Healthcare System: insights from the VA CART Program
- Author
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Paula Langner, John S. Rumsfeld, Thomas M. Maddox, Melinda B. Davis, Mary E. Plomondon, and Claire S. Duvernoy
- Subjects
Male ,medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,medicine.medical_treatment ,Veterans Health ,Comorbidity ,Coronary Artery Disease ,Kaplan-Meier Estimate ,Chest pain ,Coronary artery disease ,Stress Disorders, Post-Traumatic ,Sex Factors ,Risk Factors ,medicine ,Humans ,Obesity ,Veterans Affairs ,Depression (differential diagnoses) ,Cardiac catheterization ,Aged ,Proportional Hazards Models ,business.industry ,Depression ,Hazard ratio ,Percutaneous coronary intervention ,Health Status Disparities ,Middle Aged ,medicine.disease ,United States ,United States Department of Veterans Affairs ,Treatment Outcome ,Emergency medicine ,Physical therapy ,Female ,medicine.symptom ,Outcomes research ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background— The number of women veterans is increasing, yet little is known about their cardiovascular risk factors, coronary anatomy, cardiac treatments, and outcomes after cardiac catheterization. Prior studies have shown that nonveteran women have more risk factors, receive less aggressive treatment, and have worse outcomes, despite having less obstructive coronary artery disease than men. Whether these differences exist among women veterans in the veterans affairs healthcare system is unknown. Methods and Results— Data on 85 936 veterans (3181 women) undergoing initial cardiac catheterization between October 1, 2007, and September 30, 2012, were examined using the national veterans affairs Clinical Assessment Reporting and Tracking (CART) Program. Sex differences in demographics, indications, coronary anatomy, cardiac treatments, and outcomes were analyzed. Women veterans were younger (56.9 versus 63.0 years, P Conclusions— Women veterans undergoing catheterization are younger, have more obesity, depression, and posttraumatic stress disorder, less obstructive coronary artery disease, and similar long-term outcomes, compared with men. These findings suggest a significant portion of women veterans may have chest pain not attributable to obstructive coronary artery disease. Further research into possible causes, such as endothelial dysfunction or concurrent psychological comorbidities, is needed.
- Published
- 2015
29. Symptoms of Men and Women Presenting With Acute Coronary Syndromes
- Author
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Amisha Patel, David F Armstrong, Jianming Fang, Kim A. Eagle, Cynthia Arslanian-Engoren, Claire S. Duvernoy, and Eva Kline-Rogers
- Subjects
Adult ,Male ,Michigan ,medicine.medical_specialty ,Nausea ,Myocardial Infarction ,Pain ,Coronary Disease ,Sweating ,Subgroup analysis ,Comorbidity ,Diaphoresis ,Chest pain ,Logistic regression ,Angina ,Sex Factors ,Heart Conduction System ,Internal medicine ,medicine ,Humans ,Angina, Unstable ,Aged ,Aged, 80 and over ,business.industry ,Age Factors ,Syndrome ,Middle Aged ,medicine.disease ,Dyspnea ,Logistic Models ,Acute Disease ,Cardiology ,Physical therapy ,Female ,Myocardial infarction diagnosis ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study evaluated symptom similarities and differences between men and women presenting with acute coronary syndromes (ACSs) and determined whether differences in presentation are intrinsic to patient gender or to other factors. This study was a subgroup analysis of patients from an ACS registry. We compared differences in symptom presentation between men and women and analyzed them using binary logistic regression with all variables and 2 x 2 interactions. Patient gender was forced to remain in the models. Women comprised 35% of the 1,941 patients admitted with confirmed ACS. Men were more likely to present with chest pain, left arm pain, or diaphoresis. Nausea was more common in women. Dyspnea did not differ between groups. After binary logistic regression, gender remained a statistically significant predictor of diaphoresis and nausea, but not of chest or left arm pain. We found that differences in occurrence of chest pain and left arm pain between men and women are explainable by differences in co-morbidities and history; the higher occurrence of diaphoresis in men and of nausea in women is partly related to maleness or femaleness. In conclusion, gender should be considered when evaluating patients with symptoms of ACS.
- Published
- 2006
30. Self-Reported Physical Activity and Myocardial Flow Reserve in Postmenopausal Women at Risk for Cardiovascular Disease
- Author
-
Claire S. Duvernoy, Julie W. Martin, Kerri Briesmiester, Otto Muzik, and Lori Mosca
- Subjects
medicine.medical_specialty ,Health Behavior ,Physical activity ,Coronary Disease ,Disease ,Vascular reactivity ,Ammonia ,Risk Factors ,Regular exercise ,Coronary Circulation ,Internal medicine ,medicine ,Humans ,Exercise ,Aged ,Postmenopausal women ,business.industry ,General Medicine ,Blood flow ,Middle Aged ,Coronary Vessels ,Coronary heart disease ,Postmenopause ,Cross-Sectional Studies ,Cardiology ,Physical therapy ,Female ,Endothelium, Vascular ,business ,Tomography, Emission-Computed ,Biomedical sciences - Abstract
Background: Regular exercise protects against coronary heart disease (CHD) events and improves vascular reactivity. Exercise effects on myocardial flow reserve (MFR) are not well studied. Methods: We performed dynamic N-13 ammonia positron emission tomography (PET) in 16 postmenopausal women (60 ± 6 years) to measure myocardial blood flow (MBF) and MFR. We also obtained information from each woman on her self-reported physical activity. Results: Of the 16 patients, 6 reported moderate regular physical activity, and 10 did not. Women who reported regular, at least moderate physical activity had a higher percentage increase in adenosine MBF from rest compared with women who did not exercise (268% vs. 129%, p = 0.04) and had a significantly higher mean maximal MFR (3.68 vs. 2.29, p = 0.04). Conclusions: These findings provide further mechanistic support for the beneficial cardiovascular effects of exercise.
- Published
- 2006
31. Vascular events in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial: incidence, patient characteristics, and effect of raloxifene
- Author
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Cheryl A. Keech, Sherie A. Dowsett, Pandurang M. Kulkarni, and Claire S. Duvernoy
- Subjects
Blood Glucose ,Selective Estrogen Receptor Modulators ,medicine.medical_specialty ,Population ,Placebo-controlled study ,Placebo ,Leukocyte Count ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,Raloxifene ,Vascular Diseases ,cardiovascular diseases ,education ,Antihypertensive Agents ,Osteoporosis, Postmenopausal ,Triglycerides ,Aged ,Hypolipidemic Agents ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Body Weight ,Hazard ratio ,Age Factors ,Obstetrics and Gynecology ,Middle Aged ,Surgery ,Cholesterol ,Raloxifene Hydrochloride ,Hypertension ,Cohort ,Cardiology ,Female ,business ,medicine.drug - Abstract
Objective: To determine the incidence of arterial and venous thromboembolic (VTE) events, to determine the effect of raloxifene on the incidence of combined vascular (arterial and VTE) events, and to identify patient characteristics associated with these vascular events, in women participating in the MORE trial. Design: In a post hoc analysis using MORE data, arterial, VTE, and combined vascular event rates were compared between participants receiving placebo (n = 2,576) and those receiving 60 mg/d of raloxifene (n = 2,557). Baseline characteristics were compared between those who did and did not experience an arterial event. The same analysis was performed for VTE events. Results: Overall, during a mean follow-up time of 41 months, 178 women experienced an arterial event and 40 experienced a VTE event. In the placebo group, the incidence of arterial events exceeded VTE events by at least sevenfold. Raloxifene had no significant effect on the incidence of combined vascular events in the overall cohort (hazard ratio 0.95, 95% CI, 0.73-1.24). In a subset of women retrospectively determined to be at increased cardiovascular risk, raloxifene was associated with a lower incidence of combined vascular events (hazard ratio 0.63, 95% CI, 0.40-0.97). Baseline characteristics differed between those who did and those who did not experience an arterial event, but this was generally not the case for VTE events. Conclusions: Arterial events were more common than VTE events. The characteristics of women experiencing an arterial event differed from those experiencing a VTE event. Raloxifene had a neutral effect on the risk of combined vascular events in the overall population, and was associated with a reduced combined vascular event rate in women at increased cardiovascular risk. Additional studies are needed to confirm the effect of raloxifene on overall vascular outcomes.
- Published
- 2005
32. Interactive effects of the ACE DD polymorphism with the NOS III homozygous G849T (Glu298→Asp) variant in determining endothelial function in coronary artery disease
- Author
-
Michael A. Schmidt, Robert D. Brook, Anthony A. Killeen, Sanjay Rajagopalan, Dana Pfeninnger, Claire S. Duvernoy, Anjan Chakrabarti, Chris Kehrer, and Niko Kaciroti
- Subjects
Male ,medicine.medical_specialty ,Brachial Artery ,Nitric Oxide Synthase Type III ,Endothelium ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Polymerase Chain Reaction ,law.invention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,Renin ,Genotype ,medicine ,Humans ,Genetic Predisposition to Disease ,030212 general & internal medicine ,Gene ,Polymerase chain reaction ,Aged ,DNA Primers ,Cardiac catheterization ,Polymorphism, Genetic ,biology ,business.industry ,Homozygote ,DNA ,Middle Aged ,medicine.disease ,Vasodilation ,Nitric oxide synthase ,medicine.anatomical_structure ,Endocrinology ,biology.protein ,Female ,Endothelium, Vascular ,Nitric Oxide Synthase ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
The products of nitric oxide synthase (NOS) and angiotensin-converting enzyme (ACE) play a critical role in determining vessel wall structure and function. Polymorphisms in both genes have been independently demonstrated to influence propensity to cardiovascular events. The purpose of this study was to determine the influence of the homozygous G849T(Glu298 Asp) polymorphism in NOS III on peripheral conduit artery endothelial function and to elucidate the modifier role, if any, of a common ACE polymorphism. Three hundred and ninety-seven consecutive subjects presenting to the cardiac catheterization laboratory of the University of Michigan over a period of 18 months were recruited. DNA was extracted and polymerase chain reaction (PCR) analysis for ACE and NOS polymorphisms performed. Patients with homozygosity for G849T at both loci (TT) who belong to DD and II ACE genotype (groups 1 and 2) and those who are negative for this polymorphism (GG) and belong to either DD or II genotype (groups 3 and 4) were identified. The four groups then underwent determination of conduit endothelial function. Heterozygosity of Glu298-Asp or the ID variant of the ACE were not studied. Median FMD value in the TT-DD group was 0.20 (-3.17, 2.01) compared with 2.23% (-0.29, 4.17) in the GG-II group. Median values in the TT-II and the GG-DD groups were 3.04 (-1.16, 6.61) and 2.46% (-1.83, 6.52) respectively. These values were not statistically significant (p > 0.05 by one-way ANOVA). Median nitroglycerin-mediated dilation in the four groups did not differ between the four groups (p = NS by ANOVA). Atherosclerosis burdens as assessed by angiography were not different across the groups. In conclusion, the homozygous NOS III variant (GG) status does not seem to interact additively with the ACE homozygous DD genotype in determining flow-mediated vasodilation in individuals with established atherosclerosis and pre-existent endothelial dysfunction.
- Published
- 2003
33. Hormone replacement therapy trials: An update
- Author
-
Claire S. Duvernoy and Lori Mosca
- Subjects
Selective Estrogen Receptor Modulators ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Coronary Disease ,Phytoestrogens ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Humans ,Medicine ,Estrogens, Non-Steroidal ,Adverse effect ,education ,Randomized Controlled Trials as Topic ,education.field_of_study ,business.industry ,Estrogen Replacement Therapy ,Middle Aged ,Isoflavones ,Postmenopause ,Primary Prevention ,Tamoxifen ,Selective estrogen receptor modulator ,Transgender hormone therapy ,Raloxifene Hydrochloride ,Physical therapy ,Female ,Observational study ,Plant Preparations ,Hormone therapy ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Recent randomized trials of hormone replacement therapy (HRT) in postmenopausal women are not consistent with the decrease in cardiovascular risk seen in observational studies of hormone therapy users compared with nonusers. Emerging evidence indicates that HRT use in some women with established coronary heart disease may be associated with prothrombotic effects or proinflammatory effects leading to adverse events. In healthy women, the decision to use HRT should be based primarily on non-cardiac factors until more data becomes available that is relevant to this population. Several alternatives to HRT, including phytoestrogens and selective estrogen receptor modulators, have favorable effects on cardiovascular risk factors, but their impact on clinical outcomes remains to be determined.
- Published
- 2002
34. Assessment of Diagnostic Performance of Quantitative Flow Measurements in Normal Subjects and Patients With Angiographically Documented Coronary Artery Disease by Means of Nitrogen-13 Ammonia and Positron Emission Tomography
- Author
-
Markus Schwaiger, Rob S. Beanlands, Otto Muzik, Claire S. Duvernoy, Edwin R. Wolfe, Firat Dayanikli, and Stephen Sawada
- Subjects
Adult ,Male ,Coronary Disease ,Coronary Angiography ,Severity of Illness Index ,Coronary artery disease ,Ammonia ,Predictive Value of Tests ,Coronary Circulation ,Medicine ,Humans ,In patient ,Aged ,Nitrogen Radioisotopes ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Curve analysis ,Confounding Factors, Epidemiologic ,Blood flow ,Middle Aged ,medicine.disease ,Stenosis ,ROC Curve ,Positron emission tomography ,Female ,business ,Nuclear medicine ,Cardiology and Cardiovascular Medicine ,Perfusion ,Blood Flow Velocity ,Tomography, Emission-Computed - Abstract
Regional myocardial blood flow (MBF) and flow reserve measurements using nitrogen-13 (N-13) ammonia positron emission tomography (PET) were compared with quantitative coronary angiography to determine their utility in the detection of significant coronary artery disease (CAD).Dynamic PET protocols using N-13 ammonia allow regional quantification of MBF and flow reserve. To establish the diagnostic performance of this method, the sensitivity and specificity must be known for varying decision thresholds.MBF and flow reserve for three coronary territories were determined in 20 normal subjects and 31 patients with angiographically documented CAD by means of dynamic PET and a three-compartment model for N-13 ammonia kinetics. Ten normal subjects defined the normal mean and SD of MBF and flow reserve, and 10 normal subjects were compared with patients. PET flow obtained in the territory with the most severe stenosis in each patient was correlated with the angiographic assessment of the stenosis (severityor = 50%,or = 70%,or = 90%). Receiver operating characteristic (ROC) curve analysis was performed for 1.5, 2.0, 2.5, 3.0 and 4.0 SD of flow abnormalities.MBF and flow reserve values from the normal subjects and from territories with documented stenosesor = 50% were significantly different (p0.05). A significant difference was found between normal subjects and angiographically normal territories of patients with CAD. High diagnostic accuracy and sensitivity, with moderately high specificity, were demonstrated for detection of all stenoses.Quantification of myocardial perfusion using dynamic PET and N-13 ammonia provides a high performance level for the detection and localization of CAD. The specificity of dynamic PET was excellent in patients with a low likelihood of CAD, whereas an abnormal flow reserve in angiographically normal territories was postulated to represent early functional abnormalities of vascular reactivity.
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- 1998
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35. Current role of sodium bicarbonate-based preprocedural hydration for the prevention of contrast-induced acute kidney injury: a meta-analysis
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Brahmajee K. Nallamothu, Hitinder S. Gurm, Stanley Chetcuti, Mauro Moscucci, P. Michael Grossman, Phillipe L'Allier, Shea Elizabeth Hogan, Eric R. Bates, and Claire S. Duvernoy
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Contrast Media ,Context (language use) ,Sodium Chloride ,law.invention ,chemistry.chemical_compound ,Randomized controlled trial ,law ,medicine ,Odds Ratio ,Humans ,Aged ,Randomized Controlled Trials as Topic ,Sodium bicarbonate ,business.industry ,Acute kidney injury ,Publication bias ,medicine.disease ,Surgery ,Solutions ,Sodium Bicarbonate ,chemistry ,Anesthesia ,Relative risk ,Acute Disease ,Fluid Therapy ,Female ,Kidney Diseases ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Background The optimal hydration strategy for prevention of contrast-induced acute kidney injury (AKI) remains unknown. The purpose of this meta-analysis is to compare the effectiveness of normal saline (NS) versus sodium bicarbonate hydration (NaHCO 3 ) for prevention of contrast-induced AKI. Methods We performed a meta-analysis of randomized controlled trials that compared saline-based hydration with sodium bicarbonate–based hydration regimen for prophylaxis of contrast-induced AKI. The literature search included MEDLINE, EMBASE, and Cochrane databases (2000 to October 2007); conference proceedings; and bibliographies of retrieved articles. Information was extracted on study design, sample characteristics, and interventions. Random-effects models were used to calculate summary risk ratios for contrast-induced AKI, need for hemodialysis, and death. Results Seven trials with 1,307 subjects were included. Preprocedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of contrast-induced AKI (5.96% in the NaHCO 3 arm versus 17.23% in the NS arm, summary risk ratio 0.37, 95% CI 0.18-0.714, P = .005). There was no difference in the rates of postprocedure hemodialysis or death. Formal testing revealed moderate heterogeneity and a strong likelihood of publication bias. Conclusions Although sodium bicarbonate hydration was found to be superior to NS in prevention of contrast-induced AKI, these results are in the context of study heterogeneity and, likely, publication bias. An adequately powered randomized controlled trial is warranted to define the optimal hydration strategy in patients at high risk of contrast-induced AKI who are scheduled to undergo contrast administration.
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- 2008
36. Myocardial blood flow and flow reserve in response to hormone therapy in postmenopausal women with risk factors for coronary disease
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Otto Muzik, A. Bargardi, Kerri Briesmiester, Claire S. Duvernoy, Julie W. Martin, and Lori Mosca
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medicine.medical_specialty ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Clinical Biochemistry ,Hemodynamics ,Coronary Artery Disease ,Biochemistry ,Endocrinology ,Ammonia ,Risk Factors ,Internal medicine ,Coronary Circulation ,medicine ,Humans ,Risk factor ,Progesterone ,Aged ,Cross-Over Studies ,Nitrogen Radioisotopes ,business.industry ,Microcirculation ,Biochemistry (medical) ,Estrogen Replacement Therapy ,Cold pressor test ,Hormone replacement therapy (menopause) ,Estrogens ,Middle Aged ,Adenosine ,Crossover study ,Postmenopause ,Estrogen ,Female ,Hormone therapy ,business ,medicine.drug ,Tomography, Emission-Computed - Abstract
Estrogen has beneficial effects on markers of coronary heart disease (CHD) risk, but may increase overall CHD events. The effects of hormone therapy on vascular endothelial function have been mixed, and require further assessment. We studied the myocardial blood flow (MBF) response to postmenopausal combination hormone therapy (CHT) in postmenopausal women with risk factors for CHD. We performed dynamic [13N]ammonia positron emission tomography in 15 postmenopausal women in a 7-month placebo-controlled crossover trial of continuous conjugated equine estrogen/cyclical micronized progesterone. MBF was measured at rest, after sympathetic stimulation with the cold pressor test (CPT), and after iv adenosine infusion, to determine baseline, endothelium-dependent, and maximal flows, respectively. Response to CPT was neutral in all women at baseline (−0.51 ± 27%). Adenosine induced a marked increase in MBF (161 ± 111%). Treatment with 3 months of combined estrogen/progestin CHT did not change CPT or adenosine MBF responses. Myocardial flow reserve was unchanged as well. In this group of postmenopausal women at higher cardiovascular risk, no association was found between CHT assignment and change in MBF. Further study is needed to clarify the effects of CHT on the endothelium of women with presumably diseased vasculature.
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- 2004
37. Improved detection of left main coronary artery disease with attenuation-corrected SPECT
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Patricia A. Rose, Mark Z. Karabajakian, Edward P. Ficaro, Claire S. Duvernoy, and James R. Corbett
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Male ,Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Coronary Disease ,Single-photon emission computed tomography ,Coronary disease ,Scintigraphy ,Coronary Angiography ,Sensitivity and Specificity ,Myocardial perfusion imaging ,Internal medicine ,Image Processing, Computer-Assisted ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Left main coronary artery disease ,Aged ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Attenuation ,Thallium Radioisotopes ,Cardiology ,Female ,Tomography ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,business ,Correction for attenuation - Abstract
Myocardial perfusion imaging has demonstrated a limited sensitivity as a means of accurately identifying left main (LM) coronary disease. Because regional quantitative perfusion biases are eliminated with attenuation corrected (AC) single photon emission computed tomography (SPECT), as compared with uncorrected (NC) SPECT, we hypothesized that AC SPECT would demonstrate increased diagnostic accuracy for the detection of significant LM coronary stenosis.We studied 28 patients (23 men, 5 women; mean age, 66+/-9 years) with significant LM stenoses (or =50%) and 34 control patients (27 men, 7 women; mean age, 65+/-11 years) with 2-vessel coronary disease. Rest thallium-201 and stress technetium 99m sestamibi SPECT imaging with and without AC were performed, as described earlier. Both AC and NC images were analyzed visually and quantitatively in comparison with corresponding normal databases. A greater sensitivity for detection of an LM defect pattern (64% vs. 7%, P = .0009) with equivalent specificity (94% vs. 100%, P = not significant) was demonstrated by means of visual analysis of AC SPECT images. More disease was demonstrated in a greater number of territories with AC SPECT images than with NC images (2.14+/-0.97 for AC images vs. 1.43+/-0.84 for NC images, P = .0001). Similar improvement in the detection of LM disease was shown by means of automated quantitative analysis (57% for AC SPECT vs 14% for NC SPECT, P = .0005), again with no loss in specificity.AC SPECT with the University of Michigan method in consecutive patients with LM stenoses and a select control population with severity matched multivessel coronary disease significantly improved the diagnostic accuracy of myocardial perfusion imaging for the identification of LM coronary disease, compared with uncorrected SPECT.
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- 2001
38. Myocardial blood flow and coronary flow reserve late after anatomical correction of transposition of the great arteries
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John Hess, Otto Muzik, Markus Schwaiger, Jens Stollfuss, Frank M. Bengel, Claire S. Duvernoy, Ursula Sauer, Michael Hauser, Andreas Kuehn, Mareike Beckmann, and Sibylle Ziegler
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Male ,medicine.medical_specialty ,Heart disease ,Adolescent ,Transposition of Great Vessels ,Vasodilation ,Internal medicine ,Coronary Circulation ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Postoperative Period ,Prospective Studies ,Child ,Tomography, Emission-Computed, Single-Photon ,business.industry ,Vascular disease ,Coronary flow reserve ,Heart ,Blood flow ,Transposition of the great vessels ,medicine.disease ,Coronary Vessels ,Coronary arteries ,medicine.anatomical_structure ,Great arteries ,Regional Blood Flow ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Objectives. Myocardial blood flow (MBF) in children late after arterial switch operation (ASO) was investigated quantitatively by positron emission tomography (PET).Background. In children with transposition of the great arteries (TGA), ASO is widely accepted as the management of choice. The long-term patency of coronary arteries after surgical transfer to the neo-aorta, however, remains a concern.Methods. Twenty-two normally developed, symptom-free children were investigated by PET with nitrogen-13 ammonia at rest and during adenosine vasodilation 10 ± 1 years after ASO. A subgroup of 15 children (9 ± 1 years; group A) had simple TGA and underwent ASO within 20 days after birth while 7 (13 ± 3 years; group B) had complex TGA and underwent ASO and correction of associated anomalies later after birth. Ten young, healthy adults (26 ± 6 years) served as the control group.Results. Resting MBF was not different between groups. After correction for the rate-pressure product as an index of cardiac work, younger children of group A had significantly higher MBF at rest compared to healthy adults (102 ± 29 vs. 77 ± 16 ml/100 g/min; p = 0.012) while flow in group B was not different from the other groups (85 ± 22 ml/100 g/min; p = NS). Hyperemic blood flows were significantly lower in both groups after ASO compared to normals (290 ± 42 ml/100 g/min for group A, 240 ± 28 for group B, 340 ± 57 for normals; p < 0.01); thus, coronary flow reserve was significantly lower in both groups after ASO compared to healthy adults (3.0 ± 0.6 for group A, 2.9 ± 0.6 for group B, 4.6 ± 0.9 for normals; p < 0.01).Conclusions. Blood flow measurements suggest decreased coronary reserve in the absence of ischemic symptoms in children late after arterial switch repair of TGA. The global impairment of stress flow dynamics may indicate altered vasoreactivity; however, the prognostic significance of these findings needs to be determined.
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- 1998
39. Gender differences in adverse outcomes after contemporary percutaneous coronary intervention: An analysis from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) percutaneous coronary intervention registry
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Prerana Manohar, Eva Kline-Rogers, David Share, Claire S. Duvernoy, Richard McNamara, Dean E. Smith, Hitinder S. Gurm, Mauro Moscucci, and Ann Schaefer
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Male ,Michigan ,medicine.medical_specialty ,medicine.medical_treatment ,Atherectomy ,Sex Factors ,Internal medicine ,medicine ,Humans ,Registries ,cardiovascular diseases ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Adverse effect ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Conventional PCI ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Background Prior studies have shown a relationship between female gender and adverse outcomes after percutaneous coronary interventions (PCIs). Whether this relationship still exists with contemporary PCI remains to be determined. Methods We evaluated gender differences in clinical outcomes in a large registry of contemporary PCI. Data were prospectively collected from 22,725 consecutive PCIs in a multicenter regional consortium (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) between January 2002 and December 2003. The primary end point was in-hospital all-cause mortality; other clinical outcomes evaluated included in-hospital death, vascular complications, transfusion, postprocedure myocardial infarction, stroke, and a combined major cardiovascular adverse event (MACE) end point including myocardial infarction, death, stroke, emergency coronary artery bypass grafting, and repeated PCI at the same site. Independent predictors of adverse outcomes were identified using multivariate logistic regression analysis. Results Compared with men, women were older, had a higher prevalence of comorbidities, and had a significantly higher frequency of adverse outcomes after PCI. After adjustment for baseline demographics, comorbidities, clinical presentation, and lesion characteristics, female gender was associated with an increased risk of in-hospital death, vascular complication, blood transfusion, stroke, and MACE. The relationship between female gender and increased risk of death and MACE was no longer present after further adjustment for kidney function and low body surface area. Conclusions Differences in mortality rates between men and women no longer exist after PCI. However, our data suggest that technological advancements have not completely offset the relationship between gender and adverse outcomes after PCI.
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- 2010
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