93 results on '"Athena Poppas"'
Search Results
2. Preadmission Oral Anticoagulation for Atrial Fibrillation/Flutter and Death or Thrombotic Events During COVID-19 Admission
- Author
-
David W. Louis, Kevin F. Kennedy, Marwan Saad, Greg Salber, Hafiz Imran, Tyler Wark, Cullen Soares, Dhairyasheel Ghosalkar, Rasan Cherala, Athena Poppas, J. Dawn Abbott, and Herbert D. Aronow
- Subjects
Hospitalization ,Stroke ,Atrial Flutter ,Risk Factors ,Atrial Fibrillation ,Administration, Oral ,Anticoagulants ,COVID-19 ,Humans ,Thrombosis ,Hospital Mortality ,Cardiology and Cardiovascular Medicine ,Risk Assessment - Abstract
Atrial fibrillation/flutter (AF) and COVID-19 are associated with an elevated risk of arterial and venous thrombosis. Whether preadmission oral anticoagulation (OAC) for AF reduces the incidence of in-hospital death or thrombotic events among patients with COVID-19 is unknown. We identified 630 patients with pre-existing AF and a hospitalization diagnosis of COVID-19 and stratified them according to preadmission OAC use. Multivariable logistic regression was employed to relate preadmission OAC to composite in-hospital mortality or thrombotic events. Unadjusted composite in-hospital mortality or thrombotic complications occurred less often in those on than not on preadmission OAC (27.1% vs 46.8%, plt;0.001). After adjustment, the incidence of composite in-hospital all-cause mortality or thrombotic complications remained lower with preadmission OAC (odds ratio 0.37, confidence interval 0.25 to 0.53, plt;0.0001). Secondary outcomes including all-cause mortality (16.3% vs 24.9%, p = 0.007), intensive care unit admission (14.7% vs 29.0%, plt;0.001), intubation (6.4% vs 18.6%, plt;0.001), and noninvasive ventilation (18.6% vs 27.5%, p = 0.007) occurred less frequently, and length of stay was shorter (6 vs 7 days, plt;0.001) in patients on than those not on preadmission OAC. A higher CHAsub2/subDSsub2/sub-VASc score was associated with an increased risk of thrombotic events. In conclusion, among patients with baseline AF who were hospitalized with COVID-19, those on preadmission OAC had lower rates of death, arterial and venous thrombotic events, and less severe COVID-19.
- Published
- 2022
3. Preadmission Statin Treatment and Outcome in Patients Hospitalized With COVID-19
- Author
-
Marwan Saad, Kevin F. Kennedy, David W. Louis, Hafiz Imran, Charles F. Sherrod, Karen Aspry, Amgad Mentias, Athena Poppas, J. Dawn Abbott, and Herbert D. Aronow
- Subjects
Inflammation ,Male ,C-Reactive Protein ,Treatment Outcome ,COVID-19 ,Humans ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,Troponin ,Aged - Abstract
Preadmission statin therapy is associated with improved outcome in patients hospitalized with COVID-19. Whether inhibition of inflammation and myocardial injury are in part responsible for this observation has not been studied. The aim of the present study was to relate preadmission statin usage to markers of inflammation, myocardial injury, and clinical outcome among patients with established atherosclerosis who were admitted with COVID-19. Adult patients with a diagnosis of coronary artery disease, peripheral artery disease, and/or atherosclerotic cerebrovascular disease who were hospitalized with COVID-19 between March 1, 2020 and December 31, 2020 were included. Statin use was related to the primary composite clinical outcome, death, intensive care unit admission, or thrombotic complications in sequential multivariable logistic regression models. Of 3,584 adult patients who were hospitalized with COVID-19, 1,360 patients met study inclusion criteria (mean age 73.8 years, 45% women, 68% White). Baseline troponin and C-reactive protein were lower in patients on statins before admission. In an unadjusted model, preadmission statin usage was associated with a significant reduction in the primary composite outcome (42.2% vs 53.7%, odds ratio 0.63 [95% confidence interval 0.50 to 0.80], p0.001). This association remained significant after age, gender, ethnicity, other patient clinical characteristics, and cardiovascular medications were added to the model but became null when troponin and C-reactive protein were also included (odds ratio 0.83 [95% confidence interval 0.63 to 1.09] p = 0.18). In conclusion, among patients with established cardiovascular disease who were hospitalized with COVID-19, preadmission statin therapy was associated with improved in-hospital outcome, an association that was negated once inflammation and myocardial injury were considered.
- Published
- 2022
4. Impact of Bioprosthetic Valve Dysfunction on Pregnancy Outcomes: Left Side, Right Side, and Beyond
- Author
-
Deirdre J, Mattina, Katharine, French, and Athena, Poppas
- Subjects
Bioprosthesis ,Pregnancy ,Heart Valve Prosthesis ,Humans ,Female - Published
- 2022
5. 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
- Author
-
Fausto J. Pinto, Stephan Achenbach, Athena Poppas, Laxmi S. Mehta, and Mitchell S.V. Elkind
- Subjects
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
6. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report
- Author
-
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
- Subjects
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
7. Global Differences in Parental Leave Policies and Satisfaction Among Cardiologists
- Author
-
Shiavax J. Rao, Pamela S. Douglas, Anne Rzeszut, Yaa Adoma Kwapong, Sharonne N. Hayes, Athena Poppas, Laxmi S. Mehta, Roger S. Blumenthal, and Garima Sharma
- Subjects
Male ,Cardiologists ,Policy ,Work-Life Balance ,Humans ,Female ,General Medicine ,Personal Satisfaction ,Cardiology and Cardiovascular Medicine ,United States ,Parental Leave - Abstract
Gender and regional differences in paid parental leave among cardiologists worldwide has not been documented. We investigated differences in paid parental leave policies globally. There are significant regional differences in parental leave among cardiologists, with North America having the shortest duration for both men and women, and highest dissatisfaction. Both genders reported similar levels of dissatisfaction with parental leave policies worldwide. Most cardiologists in the United States were not aware of policy around adjustment of productivity expectations for the paid time off and one in five said that they did not receive an adjustment. This should be addressed by institutions to allow for career flexibility and work life balance.
- Published
- 2022
8. Diversity and Inclusion
- Author
-
Pamela S. Douglas, Athena Poppas, Quinn Capers, and Michelle A. Albert
- Subjects
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
- Published
- 2020
9. Cerebrovascular Perfusion among Older Adults with and Without Cardiovascular Disease
- Author
-
Bindal Makwana, Athena Poppas, Ronald A. Cohen, Ariana Tart‐Zelvin, Xiaomeng Xu, Denise M. Cote, John Gunstad, and Lawrence H. Sweet
- Subjects
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.
- Published
- 2020
10. Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction
- Author
-
Kenneth E Wood, Kevin F. Kennedy, J. Dawn Abbott, Marwan Saad, Hafiz Imran, Ernie Shippey, Herbert D. Aronow, David W. Louis, and Athena Poppas
- Subjects
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.
- Published
- 2021
11. 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
- Author
-
Stephan Achenbach, Laxmi S. Mehta, Mitchell S.V. Elkind, Athena Poppas, and Fausto J. Pinto
- Subjects
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
12. 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
- Author
-
Fausto J. Pinto, Mitchell S.V. Elkind, Athena Poppas, Stephan Achenbach, and Jeffrey Willett
- Subjects
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
13. 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
- Author
-
Athena Poppas, Fausto J. Pinto, Stephan Achenbach, Laxmi S. Mehta, and Mitchell S.V. Elkind
- Subjects
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
14. ACC.21 Virtual: Experience an Opportunity to Reconnect and Engage
- Author
-
Athena, Poppas, Pamela B, Morris, and Douglas, Drachman
- Subjects
Education, Distance ,Cardiovascular Diseases ,Communication ,Cardiology ,Virtual Reality ,Humans ,Education, Medical, Continuing ,Congresses as Topic - Published
- 2021
15. Global Prevalence and Impact of Hostility, Discrimination, and Harassment in the Cardiology Workplace
- Author
-
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
- Subjects
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.
- Published
- 2021
16. COVID-19 and the Athlete: Gaining Ground But Not Yet at the Finish
- Author
-
Athena, Poppas, Eugene H, Chung, and Richard, Kovacs
- Subjects
COVID-19 ,Magnetic Resonance Imaging, Cine ,Sports Medicine ,Return to Sport ,Myocarditis ,Wearable Electronic Devices ,Death, Sudden, Cardiac ,Practice Guidelines as Topic ,Humans ,Mass Screening ,Registries ,Leadership Page ,Pandemics ,Algorithms - Published
- 2021
17. Insights from the Menstrual Cycle in Pulmonary Arterial Hypertension
- Author
-
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
- Subjects
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
- Published
- 2021
18. 2020: A Year to Remember-And From Which to Learn
- Author
-
Athena, Poppas
- Subjects
Cardiovascular Diseases ,COVID-19 ,Humans ,Comorbidity ,Pandemics ,United States - Published
- 2021
19. Is Maternal Obesity the Achilles' Heel of Sustainable Efforts to Reduce Adverse Pregnancy Outcomes?
- Author
-
Athena Poppas, Garima Sharma, and Roger S. Blumenthal
- Subjects
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
20. NCDR: Advancing Patient Care, Outcomes, and Value Through Innovation and Knowledge
- Author
-
Athena Poppas and Frederick A. Masoudi
- Subjects
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
21. The Tobacco Endgame—Eradicating a Worsening Epidemic
- Author
-
Mitchell S.V. Elkind, Stephan Achenbach, Jeffrey Willett, Athena Poppas, and Fausto J. Pinto
- Subjects
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
22. ACC Education Today: Ancora Imparo (I Am Still Learning)
- Author
-
Athena, Poppas and Katie, Berlacher
- Subjects
Cardiovascular Diseases ,Cardiology ,COVID-19 ,Humans ,Learning ,Leadership Page ,United States - Published
- 2020
23. Global Health Commitment: Now More Than Ever
- Author
-
Athena, Poppas
- Subjects
Cardiovascular Diseases ,Heart Disease Risk Factors ,Preventive Health Services ,Prevalence ,Humans ,Global Health ,Quality Improvement - Published
- 2020
24. Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment
- Author
-
Robert A. Harrington, Dan M. Roden, Andrea M. Russo, and Athena Poppas
- Subjects
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
25. Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: a survey by the European Society of Cardiology
- Author
-
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
- Subjects
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.
- Published
- 2020
- Full Text
- View/download PDF
26. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership
- Author
-
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
- Published
- 2020
27. Impact of Live, Scientific Annual Meetings in Today’s Cardiovascular World
- Author
-
Jeffrey T. Kuvin, Andrew M. Kates, Pamela J. Morris, and Athena Poppas
- Subjects
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.
- Published
- 2018
28. Echocardiographic Pulmonary Hypertension Predicts Post-transplantation Renal Allograft Failure
- Author
-
Paul E. Morrissey, Grayson L. Baird, James R. Klinger, Reginald Y. Gohh, Athena Poppas, A. Bazargan-Lari, Corey E. Ventetuolo, and Andrew Foderaro
- Subjects
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.
- Published
- 2017
29. Representation of Women in American College of Cardiology/American Heart Association Guideline Writing Committees
- Author
-
Amartya Kundu, Athena Poppas, Partha Sardar, and J. Dawn Abbott
- Subjects
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
- Published
- 2018
30. Rheumatic Heart Disease in Pregnancy
- Author
-
Katharine French and Athena Poppas
- Subjects
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.
- Published
- 2018
31. Sex Differences in Cardiovascular Disease and Cognitive Impairment: Another Health Disparity for Women?
- Author
-
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
- Subjects
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.
- Published
- 2019
32. Sensitivity and Specificity of B-Type Natriuretic Peptide in Diagnosing Heart Failure in Pregnancy
- Author
-
Christopher Thomas Nau, Isabelle Malhamé, Heather Hurlburt, Ghada Bourjeily, Athena Poppas, Lucia Larson, and Niharika Mehta
- Subjects
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
33. Left Atrial Volume Index Is Associated With Cardioembolic Stroke and Atrial Fibrillation Detection After Embolic Stroke of Undetermined Source
- Author
-
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.
- Published
- 2019
34. Burnout and Career Satisfaction Among U.S. Cardiologists
- Author
-
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
- Published
- 2019
35. The left atrial appendage morphology is associated with embolic stroke subtypes using a simple classification system: A proof of concept study
- Author
-
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
36. Tissue-Based Markers of Right Ventricular Dysfunction in Ischemic Mitral Regurgitation Assessed via Stress Cardiac Magnetic Resonance and Three-Dimensional Echocardiography
- Author
-
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
37. Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke
- Author
-
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
38. Risk of Echocardiographic Pulmonary Hypertension in Individuals with Human Immunodeficiency Virus–Hepatitis C Virus Coinfection
- Author
-
Lynn E. Taylor, Athena Poppas, Rohit B. Sangal, James R. Klinger, Corey E. Ventetuolo, and Fizza S. Gillani
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Hypertension, Pulmonary ,Hepatitis C virus ,HIV Infections ,Hepacivirus ,medicine.disease_cause ,Gastroenterology ,Virus ,Risk Factors ,Internal medicine ,Odds Ratio ,Prevalence ,medicine ,Humans ,Pulmonary Wedge Pressure ,Risk factor ,Original Research ,Retrospective Studies ,Coinfection ,business.industry ,HIV ,Rhode Island ,virus diseases ,Retrospective cohort study ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Echocardiography ,Immunology ,Female ,business ,Viral load ,Follow-Up Studies - Abstract
Human immunodeficiency virus (HIV) infection is a risk factor for pulmonary hypertension (PH). Chronic hepatitis C virus (HCV) infection may have unique or synergistic effects on the pulmonary vasculature, but the prevalence and risk factors for PH in HIV-HCV coinfected persons are not known.To define the prevalence of echocardiographic PH in a cohort of patients with HIV-HCV coinfection, to compare this estimate with the reported prevalence of PH among those with HIV infection alone, and to identify potential risk factors for PH in coinfected individuals.We performed a retrospective study of HIV-HCV coinfected patients followed at our institution from 2003 to 2012 with evidence of HCV infection (positive HCV antibody, measurable HCV ribonucleic acid viral load, and/or genotype) within 6 months of transthoracic echocardiogram. PH was defined by an estimated pulmonary artery systolic pressure (PASP) of greater than or equal to 40 mm Hg or more than moderate right ventricular dysfunction. We excluded those diagnosed with cirrhosis, left ventricular ejection fraction less than 50%, or more than moderate aortic or mitral valve disease.Sixty-eight patients were included, and 43 had adequate estimates of PASP. The median (interquartile range) age was 52 (48-57) years, and 45 (67%) were men. Eight (19%) had PH, and three (7%) had more than moderate right ventricular dysfunction. After age and sex adjustment, interferon (IFN)-based HCV treatment was associated with higher PASP (β, 6.00 mm Hg; 95% confidence interval, 0.09-11.90; P = 0.047) and with the risk of PH (odds ratio, 5.65; 95% confidence interval, 1.07-29.93; P = 0.042). These associations persisted after adjustment for comorbidities but were attenuated by adjustment for duration of HCV diagnosis.The prevalence of echocardiographic PH may be higher in HIV-HCV coinfected individuals than in those with HIV monoinfection. IFN-based HCV treatment and time since HCV diagnosis were associated with the development of PH as assessed by echocardiography. Further studies are needed to examine HIV-HCV coinfection, HCV treatment, and duration of infection as possible causes of pulmonary vascular disease.
- Published
- 2014
39. The impact of hypertension on cerebral perfusion and cortical thickness in older adults
- Author
-
Ronald A. Cohen, Athena Poppas, Michael L. Alosco, John Gunstad, Gretel Terrero, Lawrence H. Sweet, Donald R. Labbe, Uraina S. Clark, Hannah Riskin-Jones, Edward G. Walsh, Xiaomeng Xu, and Nicolette F. Schwarz
- Subjects
Male ,medicine.medical_specialty ,Blood Pressure ,Perfusion scanning ,Cerebral autoregulation ,Article ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Cerebral perfusion pressure ,Aged ,Cerebral Cortex ,medicine.diagnostic_test ,business.industry ,Dementia, Vascular ,Parietal lobe ,Magnetic resonance imaging ,Middle Aged ,Magnetic Resonance Imaging ,Surgery ,Blood pressure ,medicine.anatomical_structure ,Cerebral blood flow ,Regional Blood Flow ,Cerebral cortex ,Cerebrovascular Circulation ,Hypertension ,Disease Progression ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Hypertension may increase risk for dementia possibly because of its association with decreased cortical thickness. Disturbed cerebral autoregulation is one plausible mechanism by which hypertension impacts the cerebral structure, but the associations among hypertension, brain perfusion, and cortical thickness are poorly understood. The current sample consisted of 58 older adults with varying levels of vascular disease. Diagnostic history of hypertension and antihypertensive medication status was ascertained through self-report, and when available, confirmed by medical record review. All participants underwent arterial spin labeling and T1-weighted magnetic resonance imaging to quantify total and regional cortical perfusion and thickness. Analysis of covariance adjusting for medical variables showed that participants with hypertension exhibited reduced temporal and occipital brain perfusion and total and regional cortical thickness relative to those without hypertension. The effects of hypertension on total brain perfusion remained unchanged even after adjustment for age, although no such pattern emerged for cortical thickness. Decreased total brain perfusion predicted reduced thickness of the total brain and of the frontal, temporal, and parietal lobe cortices. Antihypertensive treatment was not associated with total cerebral perfusion or cortical thickness. This study provides initial evidence for the adverse effects of a diagnostic history of hypertension on brain hypoperfusion and reduced cortical thickness. Longitudinal studies are needed to investigate the role of hypertension and its interaction with other contributing factors (eg, age) in the manifestation of cerebral hypoperfusion and reduced cortical thickness.
- Published
- 2014
40. Left atrial size is independently associated with cognitive function
- Author
-
John Gunstad, Beth A. Jerskey, Uraina S. Clark, Xiaomeng Xu, Athena Poppas, Michael L. Alosco, Ronald A. Cohen, Lawrence H. Sweet, and Jason Hassenstab
- Subjects
Male ,Repeatable Battery for the Assessment of Neuropsychological Status ,medicine.medical_specialty ,Neuroimaging ,Neuropsychological Tests ,Article ,Internal medicine ,medicine ,Humans ,Heart Atria ,Prospective cohort study ,Depression (differential diagnoses) ,Aged ,medicine.diagnostic_test ,Depression ,business.industry ,General Neuroscience ,Brain ,Cognition ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Cardiovascular Diseases ,Echocardiography ,Cardiology ,Regression Analysis ,Female ,Cognition Disorders ,business ,Psychosocial ,Neurocognitive - Abstract
Left atrial (LA) diameter is easily attainable from echocardiograph and sensitive to underlying cardiovascular disease severity, although its association with neurocognitive outcomes is not well understood. Fifty older adults (64.50 ± 9.41 years), recruited from outpatient cardiology clinics and local papers who underwent magnetic resonance imaging, were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and completed psychosocial self-report measures. LA diameter was quantified using echocardiogram. Hierarchical regression analyses revealed that greater LA size was independently associated with reduced performance on the following RBANS composites: language, delayed memory, and total index (p0.05 for all). Hierarchical regression analysis demonstrated no significant association between LA diameter and whole brain volume (p0.05). The current study suggests that greater LA size is associated with cognitive dysfunction in older adults and prospective studies are needed to validate these findings and elucidate underlying mechanisms.
- Published
- 2013
41. Problems With Excess Mitral Leaflet After Repair: Possible Issues During Repair and Preservation of the Posterior Leaflet
- Author
-
Andrew Maslow, Arun Singh, Nikola Dobrillovic, Athena Poppas, and Feroze Mahmood
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Diastole ,Ventricular outflow tract obstruction ,Postoperative Complications ,Internal medicine ,Mitral valve ,medicine ,Humans ,Ultrasonography ,Aged, 80 and over ,Mitral valve repair ,Mitral regurgitation ,Mitral Valve Prolapse ,Cardiac cycle ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Stenosis ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Unicuspid ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
HE NORMAL NATIVE MITRAL VALVE exists in a dynamic balance involving all components of the apparatus to provide optimal coaptation during ventricular systole and minimal resistance to forward flow during ventricular diastole. The repaired myxomatous mitral valve has a similar balance, but with different annular and leaflet dimensions. Most commonly, repairs include resection and reduction of the posterior leaflet (PL) and a reduction annuloplasty, with or without repair of the anterior leaflet (AL). Green et al 1 described the postrepair PL as restricted, acting to buttress the coapting AL. Functionally, this repaired valve appears like a “unicuspid valve,” which relies heavily on a normally functioning AL. 1,2 Although not a new concept, there has been renewed interest in preserving and repairing a prolapsing PL (“respect rather than resect” [RRR]). 3-7 Proponents of RRR seek to treat the prolapse and return the PL toward a normal dimension, yielding a bileaflet valve, with a larger diastolic area and a larger coapting surface. 3-7 Whether RRR involves preservation of the entire PL 3,5-7 or a combination of resection and preservation 4 is decided case by case. The authors present 3 patients in whom repair and preservation of the PL were performed. These 3 cases represent the authors’ initial experience with the placement of new chordae to repair the PL. Two patients developed systolic anterior motion (SAM) with left ventricular outflow tract obstruction (LVOTO) and mitral regurgitation (MR), one immediately after cardiopulmonary bypass (CPB) and the other in the postoperative period. In the third patient, hemodynamic assessment showed mitral stenosis. For all 3 patients, the authors speculate that the complications were the result of excess postrepair leaflet tissue below the annular plane. CASE REPORTS Case 1 An 80-year-old woman presented with myxomatous mitral valve disease, severe MR, and a history of congestive heart failure and was scheduled for valve repair. Transesophageal echocardiography (TEE) immediately before CPB visualized a torn posterior (P) chordae, flail of the P3, and prolapse of P2 leaflet scallops (Fig 1). The AL appeared to have myxomatous changes but did not prolapse. Risk assessment for postrepair SAM was based on previously published data8 and included ratios of the systolic heights of the AL and PL (AL/PL; 0.9) and the distance from the mitral coaptation point to the proximal ventricular septum (CSEPT; 2.0 cm). Based on these data (AL/PL 1.4; CSEPT 2.5 cm), this patient was at risk for postrepair SAM and LVOTO.8
- Published
- 2013
42. Changes in the Professional Lives of Cardiologists Over 2 Decades
- Author
-
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
- Subjects
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
43. Embolization of Inferior Vena Cava Filter Tyne and Right Ventricular Perforation: A Cardiac Missile
- Author
-
Athena Poppas, Afshin Ehsan, Thomas A Ollila, George R. McKendall, and Syed S. Naeem
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Vena Cava Filters ,medicine.medical_treatment ,Heart Ventricles ,Perforation (oil well) ,Inferior vena cava filter ,030204 cardiovascular system & hematology ,Pericardial effusion ,Inferior vena cava ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Embolization ,Device Removal ,business.industry ,medicine.disease ,Embolization, Therapeutic ,Pericardial window ,Surgery ,Pulmonary embolism ,medicine.anatomical_structure ,Treatment Outcome ,medicine.vein ,Heart Injuries ,Ventricle ,cardiovascular system ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism - Abstract
Inferior vena cava (IVC) filter is a medical device placed in patients with proven pulmonary embolism or those with risk of embolization. Although many IVC filters are designed for removal after patient recovery, in many instances they are never retrieved. We present a case of a 22-year-old woman who underwent placement of an IVC filter as a prophylactic measure following a C-6 spinal injury that rendered her a quadriplegic. A tyne from the filter later fractured and embolized to the right ventricle, leading to perforation and subsequent large symptomatic pericardial effusion. The tyne was retrieved through a subxiphoid pericardial window, and the patient had an uneventful recovery. She later underwent retrieval of the entire filter.
- Published
- 2016
44. Cardiac Output, Blood Pressure Variability, and Cognitive Decline in Geriatric Cardiac Patients
- Author
-
Ronald A. Cohen, Ozioma C. Okonkwo, Athena Poppas, and John Gunstad
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac output ,Brachial Artery ,Diastole ,Blood Pressure ,Article ,Executive Function ,Internal medicine ,medicine.artery ,medicine ,Humans ,Attention ,Prospective Studies ,Cardiac Output ,Cognitive decline ,Brachial artery ,Prospective cohort study ,Aged ,Aged, 80 and over ,Ejection fraction ,business.industry ,Rehabilitation ,Ultrasonography, Doppler ,Middle Aged ,Blood pressure ,Intima-media thickness ,Cardiovascular Diseases ,Regional Blood Flow ,Cardiology ,Physical therapy ,Female ,Tunica Intima ,Cardiology and Cardiovascular Medicine ,business ,Psychomotor Performance - Abstract
OBJECTIVE: To prospectively investigate whether baseline findings on specific cardiovascular indices are predictive of subsequent rate of decline in Attention-Executive-Psychomotor function in a cohort of ambulatory older adults with cardiovascular diseases (CVDs). METHODS: One hundred seventy-two older adults with CVD were administered a neuropsychological battery of executive functions tests at study entry, and at 12 and 36 months thereafter. At study entry, they also underwent vascular assessments including cardiac output, ejection fraction, blood pressure (BP), brachial artery reactivity, and carotid intima media thickness. Random coefficient regressions were used to investigate the effect of these cardiac indices on rate of decline in Attention-Executive-Psychomotor function. RESULTS: Cardiac output, systolic BP variability, and diastolic BP variability predicted decline in Attention-Executive-Psychomotor function. Specifically, lower cardiac output, reduced variability in systolic BP, and increased variability in diastolic BP were associated with a faster rate of decline in Attention-Executive-Psychomotor function. Mean resting systolic and diastolic blood pressure did not predict decline in Attention-Executive-Psychomotor function. CONCLUSIONS: Decline in frontal-subcortical cognitive functions among patients with CVDs appears to be mediated by systemic hypoperfusion and variability in blood pressure. The precise nature of these relationships, especially with regard to blood pressure variability, is complex and demands continued investigation.
- Published
- 2011
45. Intraoperative Assessment of Mitral Valve Area After Mitral Valve Repair for Regurgitant Valves
- Author
-
Arun Singh, Andrew Maslow, Feroze Mahmood, and Athena Poppas
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Monitoring, Intraoperative ,Mitral valve ,Internal medicine ,medicine.artery ,medicine ,Humans ,Normal Sinus Rhythm ,Ultrasonography ,Heart Valve Prosthesis Implantation ,Body surface area ,Mitral valve repair ,Ejection fraction ,business.industry ,Mitral Valve Insufficiency ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Pulmonary artery ,Cardiology ,Mitral Valve ,Female ,Mitral valve area ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 37-year-old woman (body surface area 1.75 m2) was monitored using standard American Society of Anesthesiologists noninvasive monitors, intra-arterial and pulmonary artery catheters, and transesoph- ageal echocardiography (TEE). Baseline hemodynamic data are shown in Table 1. At the time of surgery, she was in a normal sinus rhythm. Before CPB, the examination showed diffuse bileaflet myxomatous dis- ease including prolapse of all scallops. There was severe mitral regur- gitation. The left ventricular ejection fraction was estimated to be 55%. Right ventricular function also was reduced. The remainder of the examination was not remarkable. The surgical procedure consisted of plication of P1 and P3, resection of P2, and placement of commissural sutures between A1 and P1 and between A3 and P3. Neochordae were placed to reduce the prolapsing middle anterior leaflet scallop. A 28-mm flexible Carpentier-Edwards (Irvine, CA) annuloplasty ring was placed. To facilitate separation from CPB, an epinephrine infusion was begun. Echocardiographic measurements and calculations of mitral valve
- Published
- 2011
46. Atlas-derived perfusion correlates of white matter hyperintensities in patients with reduced cardiac output
- Author
-
Ronald A. Cohen, Athena Poppas, Christopher M. Holland, Angela L. Jefferson, David F. Tate, Charles R.G. Guttmann, and Istvan Csapo
- Subjects
Male ,Aging ,Cardiac output ,Heart Diseases ,Statistics as Topic ,Single-photon emission computed tomography ,Doppler echocardiography ,Article ,White matter ,medicine ,Humans ,Cardiac Output ,Cerebral perfusion pressure ,Aged ,Aged, 80 and over ,Tomography, Emission-Computed, Single-Photon ,Brain Mapping ,medicine.diagnostic_test ,business.industry ,General Neuroscience ,Brain ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,Echocardiography, Doppler ,Hyperintensity ,Perfusion ,medicine.anatomical_structure ,Female ,Neurology (clinical) ,Geriatrics and Gerontology ,Nuclear medicine ,business ,Developmental Biology - Abstract
Reduced cardiac output is associated with increased white matter hyperintensities (WMH) and executive dysfunction in older adults, which may be secondary to relations between systemic and cerebral perfusion. This study preliminarily describes the regional distribution of cerebral WMH in the context of a normal cerebral perfusion atlas and aims to determine if these variables are associated with reduced cardiac output. Thirty-two participants (72 ± 8 years old, 38% female) with cardiovascular risk factors or disease underwent structural MRI acquisition at 1.5 T using a standard imaging protocol that included FLAIR sequences. WMH distribution was examined in common anatomical space using voxel-based morphometry and as a function of normal cerebral perfusion patterns by overlaying a single photon emission computed tomography (SPECT) atlas. Doppler echocardiogram data was used to dichotomize the participants on the basis of low (n = 9) and normal (n = 23) cardiac output. Global WMH count and volume did not differ between the low and normal cardiac output groups; however, atlas-derived SPECT perfusion values in regions of hyperintensities were reduced in the low versus normal cardiac output group (p < 0.001). Our preliminary data suggest that participants with low cardiac output have WMH in regions of relatively reduced perfusion, while normal cardiac output participants have WMH in regions with relatively higher regional perfusion. This spatial perfusion distribution difference for areas of WMH may occur in the context of reduced systemic perfusion, which subsequently impacts cerebral perfusion and contributes to subclinical or clinical microvascular damage.
- Published
- 2011
47. Link Between Change in Cognition and Left Ventricular Function Following Cardiac Resynchronization Therapy
- Author
-
Karin F. Hoth, Youngsoo Cho, Andrew Sokobin, Robert H. Paul, Ronald A. Cohen, Kristin E. Ellison, and Athena Poppas
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Cardiac function curve ,medicine.medical_specialty ,Time Factors ,Psychotherapist ,Psychometrics ,medicine.medical_treatment ,Statistics as Topic ,Cardiac resynchronization therapy ,Neuropsychological Tests ,Ventricular Function, Left ,Article ,Cognition ,Risk Factors ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Neuropsychological assessment ,Heart Failure ,Analysis of Variance ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Rehabilitation ,Cardiac Pacing, Artificial ,Neuropsychology ,Stroke Volume ,Stroke volume ,Middle Aged ,medicine.disease ,Heart failure ,Exercise Test ,cardiovascular system ,Cardiology ,Female ,Cognition Disorders ,Cardiology and Cardiovascular Medicine ,business ,therapeutics ,circulatory and respiratory physiology - Abstract
Purpose In patients with heart failure, reduced cardiac ejection fraction has been associated with impaired cognition. Improving cardiac function may have beneficial effects on cognition; however, no controlled intervention studies have examined this possibility. Cardiac resynchronization therapy (CRT) is one intervention that has been shown to increase cardiac function. The goals of the current study were to (1) evaluate neuropsychological performance before and 3 months after crt and (2) examine follow-up neuropsychological performance of patients classified on the basis of extent of improved left ventricular ejection fraction (LVEF). Methods Twenty-seven patients with moderate to severe heart failure completed a neuropsychological assessment, 6-minute walk test, and transthoracic echocardiography before and 3 months after CRT. Patients were classified on the basis of improvement in LVEF. Results of a multivariate analysis of variance revealed a significant effect of improvement in LVEF on change in cognition (Wilks Λ, P = .031). Results Patients with improved LVEF demonstrated significant increases on measures of executive functioning (F = 8.57, P = .007) and visuospatial function (F = 7.52, P = .011) and less decline on global cognition (F = 5.73, P = .024) than those without LVEF improvement. Conclusions Findings provide preliminary evidence that improved LVEF in response to CRT is associated with enhanced cognitive outcomes within 3 months of CRT. Patients with improved LVEF showed better outcomes on measures of executive functioning, global cognition, and visuospatial functioning. Future, controlled, large-scale trials will be necessary to determine whether there is an underlying causal relationship linking increase in LVEF and cognition.
- Published
- 2010
48. Cardiac Disease in Pregnancy: Value of Echocardiography
- Author
-
Athena Poppas and Sarah Tsiaras
- Subjects
medicine.medical_specialty ,Cardiac output ,Heart Diseases ,Heart disease ,Cardiomyopathy ,Disease ,Heart Rate ,Pregnancy ,Internal medicine ,Heart rate ,medicine ,Humans ,Cardiac Output ,Ultrasonography ,Blood Volume ,business.industry ,Hemodynamics ,medicine.disease ,Adaptation, Physiological ,United States ,medicine.anatomical_structure ,Cardiology ,Vascular resistance ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business ,Postpartum period - Abstract
Cardiovascular disease in women during pregnancy poses particular challenges. It continues to be a leading cause of maternal mortality and contributes to significant morbidity. Echocardiography is essential in characterizing the extent and effects of heart disease prior to, during, and after pregnancy. By understanding the physiologic adaptation in pregnancy with increases in heart rate, blood volume, and cardiac output, and decrease in vascular resistance, one can anticipate and recognize the effects of these changes on various cardiac lesions. Cardiomyopathy, severe, obstructive valvular disease, aortic dilation due to Marfan's disease, and cyanotic congenital heart disease are poorly tolerated in pregnancy. These disorders can be readily distinguished from normal structural changes of pregnancy and their severity assessed by echocardiography. Cardiovascular disease in women of reproductive age requires careful, multidisciplinary management by obstetric and medical teams ideally beginning preconception and continuing through the postpartum period.
- Published
- 2010
49. Longitudinal Trajectories of Cognitive Decline among Older Adults with Cardiovascular Disease
- Author
-
Michael L. Alosco, Athena Poppas, Ozioma C. Okonkwo, Geoffrey Tremont, John Gunstad, and Ronald A. Cohen
- Subjects
Male ,Gerontology ,medicine.medical_specialty ,Time Factors ,Cohort Studies ,Risk Factors ,Humans ,Medicine ,Longitudinal Studies ,Prospective Studies ,Coronary Artery Bypass ,Cognitive decline ,Risk factor ,Prospective cohort study ,Aged ,Aged, 80 and over ,Heart Failure ,Heart Valve Prosthesis Implantation ,Original Paper ,business.industry ,Neuropsychology ,Cognition ,Middle Aged ,medicine.disease ,Neurology ,Cardiovascular Diseases ,Heart failure ,Physical therapy ,Female ,Neurology (clinical) ,Cognition Disorders ,Cardiology and Cardiovascular Medicine ,business ,Neurocognitive ,Follow-Up Studies ,Cohort study - Abstract
Background: The long-term course of cognitive impairments secondary to cardiovascular disease (CVD) is unclear. In this study, we prospectively investigated the temporal pattern, rate and hierarchy of cognitive decline attributable to CVD – a risk factor for the development of vascular cognitive impairment (VCI) – and examined the influence of cardiac surgery and heart failure on cognitive decline. Methods: A total of 172 older adults with CVD were administered a comprehensive battery of neuropsychological tests at study entry, and at 12 and 36 months thereafter. Random coefficient regressions were used to investigate the temporal course, rate and hierarchy of cognitive decline, as well as to examine the effect of heart failure (reported by 21% of the sample) and cardiac surgery (reported by 44% of the sample) on trajectories of cognitive change. Results: The course of decline in cognition was linear for language and attention-executive function-psychomotor speed, and curvilinear for visuospatial abilities, memory and overall cognition. The decline in attention-executive function-psychomotor speed was smaller than the decline in other domains. The greatest decline occurred in visuospatial abilities. The rate of decline in cognition was not altered by a history of heart failure. Patients who had undergone cardiac surgery exhibited slower deceleration in their rates of decline in overall cognition. At baseline, patients with a history of heart failure had comparatively poorer attention-executive function-psychomotor speed, overall cognition and, to a lesser extent, visuospatial scores. Conclusion: There is measurable decline in neurocognitive function among patients with CVD. This decline is linear in some cognitive domains and curvilinear in others and is not attributable to the normal aging process. Cardiac surgery, but not heart failure, significantly affects the trajectory of cognitive decline. Because most vascular risk factors are modifiable, preventive measures such as lifestyle changes may be useful in retarding cognitive decline among patients with CVD, thus preventing the onset of VCI.
- Published
- 2010
50. Echocardiographic Findings and Cardiac Surgical Implications of Aortitis and Valvulitis in Behçet's Disease
- Author
-
Michael A. Coady and Athena Poppas
- Subjects
Adult ,Male ,Aortic valve ,medicine.medical_specialty ,Aortic Valve Insufficiency ,Regurgitation (circulation) ,Behcet's disease ,Disease ,Aortic aneurysm ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Arteritis ,Aortitis ,Heart Valve Prosthesis Implantation ,business.industry ,Behcet Syndrome ,Middle Aged ,Prognosis ,medicine.disease ,medicine.anatomical_structure ,Echocardiography ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Inflammatory, noninfectious aortitis is an unusual cause of aortic regurgitation and ascending aortic aneurysm formation, occurring in
- Published
- 2009
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.