63 results on '"Hena Patel"'
Search Results
2. Diagnostic Accuracy of Global Stress Myocardial Blood Flow for the Detection of Obstructive Coronary Artery Disease: findings FBom the AQUA-MBF Study
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Shuo Wang, MD, Paul Kim, MD, Haonan Wang, Ming-Yen Ng, Amita Singh, MD, Saima Mushtaq, MD, Jason Sin, Yuko Tada, MD, PhD, Elizabeth Hillier, MD, PhD, Michael Salerno, MD, PhD, Gianluca Pontone, MD, PhD, Javier Urmeneta, MD, Ibrahim Saeed, MD, Hena Patel, MD, Christian Østergaard Mariager, PhD, Victor Goh, MD, Simon Madsen, MD, Mayil Singram Krishnam, MD, Vicente Martinez, MD, Alicia Maceira, MD, PhD, FSCMR, José Vicente Monmeneu Menadas, MD, PhD, Aju Pazhenkottil, MD, Alborz Amir-Khalili, PhD, Ruyun Jin, MD, Mitchel Benovoy, Martin Janich, PhD, Andrew E Arai, Matthias Gero Friedrich, MD, and Amit Patel, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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3. Relationship Between Myocardial Blood Flow and Myocardial Strain Using stress Cardiac Magnetic Resonance
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Caroline Carter, BSc, Shuo Wang, MD, Ming-Yen Ng, Haonan Wang, Amita Singh, MD, Jason Sin, Saima Mushtaq, MD, Gianluca Pontone, MD, PhD, Hena Patel, MD, Victor Goh, MD, Pooja Patil, MD, PhD, Cristiane de Carvalho Singulane, MD, MSc, Ruyun Jin, MD, Martin Janich, PhD, and Amit Patel, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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4. Assessment of right ventricular size and function from cardiovascular magnetic resonance images using artificial intelligence
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Shuo Wang, Daksh Chauhan, Hena Patel, Alborz amir-Khalili, Isabel Ferreira da Silva, Alireza Sojoudi, Silke Friedrich, Amita Singh, Luis Landeras, Tamari Miller, Keith Ameyaw, Akhil Narang, Keigo Kawaji, Qiang Tang, Victor Mor-Avi, and Amit R. Patel
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Artificial intelligence ,Deep learning ,Right ventricular function ,Right ventricular ejection fraction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Theoretically, artificial intelligence can provide an accurate automatic solution to measure right ventricular (RV) ejection fraction (RVEF) from cardiovascular magnetic resonance (CMR) images, despite the complex RV geometry. However, in our recent study, commercially available deep learning (DL) algorithms for RVEF quantification performed poorly in some patients. The current study was designed to test the hypothesis that quantification of RV function could be improved in these patients by using more diverse CMR datasets in addition to domain-specific quantitative performance evaluation metrics during the cross-validation phase of DL algorithm development. Methods We identified 100 patients from our prior study who had the largest differences between manually measured and automated RVEF values. Automated RVEF measurements were performed using the original version of the algorithm (DL1), an updated version (DL2) developed from a dataset that included a wider range of RV pathology and validated using multiple domain-specific quantitative performance evaluation metrics, and conventional methodology performed by a core laboratory (CORE). Each of the DL-RVEF approaches was compared against CORE-RVEF reference values using linear regression and Bland–Altman analyses. Additionally, RVEF values were classified into 3 categories: ≤ 35%, 35–50%, and ≥ 50%. Agreement between RVEF classifications made by the DL approaches and the CORE measurements was tested. Results CORE-RVEF and DL-RVEFs were obtained in all patients (feasibility of 100%). DL2-RVEF correlated with CORE-RVEF better than DL1-RVEF (r = 0.87 vs. r = 0.42), with narrower limits of agreement. As a result, DL2 algorithm also showed increasing accuracy from 0.53 to 0.80 for categorizing RV function. Conclusions The use of a new DL algorithm cross-validated on a dataset with a wide range of RV pathology using multiple domain-specific metrics resulted in a considerable improvement in the accuracy of automated RVEF measurements. This improvement was demonstrated in patients whose images were the most challenging and resulted in the largest RVEF errors. These findings underscore the critical importance of this strategy in the development of DL approaches for automated CMR measurements.
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- 2022
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5. A Clinical Challenge Overcome by His Bundle Pacing
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Alison Zimmerman, MD, Hena Patel, MD, Annabelle Volgman, MD, Tochukwu Okwuosa, DO, and Parikshit S. Sharma, MD, MPH
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cardiac pacemaker ,cardiac resynchronization therapy ,electroanatomic mapping ,electrocardiography ,electrophysiology ,shortness of breath ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We highlight a diagnostic challenge in a patient with dyspnea on exertion due to radiation therapy–induced severe first-degree atrioventricular block and how permanent His bundle pacing was helpful in overcoming these symptoms. (Level of Difficulty: Intermediate.)
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- 2020
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6. The diagnostic and prognostic utility of risk factors defined by the AHA/ACCF on the evaluation of cardiac disease in liver transplantation candidates
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Sarah Alexander, Meron Teshome, Hena Patel, Edie Y. Chan, and Rami Doukky
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Liver ,Transplantation ,Coronary artery disease ,Diagnosis ,Prognosis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background The diagnostic and prognostic utility of risk factors proposed by the 2012 American Heart Association and American College of Cardiology Foundation (AHA/ACCF) Scientific Statement on the cardiac assessment of asymptomatic liver transplantation candidates have not been validated. We investigated whether the sum of risk factors proposed by the AHA/ACCF can identify liver transplant candidates at increased cardiac risk. Methods In a retrospective cohort of consecutive liver transplantation recipients, we calculated, for each subject, the pre-transplantation sum of AHA/ACCF risk factors (age > 60 years, prior cardiovascular disease, hypertension, dyslipidemia, diabetes mellitus, smoking, and left ventricular hypertrophy). The primary outcome was the presence of severe coronary artery disease (CAD), defined as ≥70% stenosis or ≥ 50% left main stenosis on pre-transplantation angiography. The secondary outcomes were the composite of cardiac death or myocardial infarction (MI) and the composite of cardiac death, MI, or coronary revascularization. Results Among 220 liver transplant recipients, the sum of AHA/ACCF risk factors had good discriminatory capacity for severe CAD [area under the curve, 0.77; 95% confidence interval (CI), 0.62–0.92; P = 0.007]; having ≥3 risk factors provided 75% sensitivity and 77% specificity for severe CAD. During mean post-transplantation follow-up of 48 ± 31 months, having ≥3 risk factors was associated with increased risk of the secondary composite outcomes of cardiac death or MI [hazard ratio, 2.39; P = 0.044] and cardiac death, MI, or coronary revascularization [hazard ratio, 2.39; P = 0.044]. Conclusions In patients undergoing cardiac assessment prior to liver transplantation, the sum of risk factors proposed by the AHA/ACCF provides significant diagnostic and prognostic utility. Having ≥3 AHA/ACCF risk factors is a reasonable threshold to prompt non-invasive stress testing in asymptomatic liver transplantation candidates.
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- 2019
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7. Nutrition Intervention for Reduction of Cardiovascular Risk in African Americans Using the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines
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Kim Allan Williams, Ibtihaj Fughhi, Setri Fugar, Monica Mazur, Sharon Gates, Stephen Sawyer, Hena Patel, Darrius Chambers, Ronald McDaniel, Jochen R. Reiser, and Terry Mason
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African Americans ,cardiovascular risk ,nutrition intervention ,plant-based diet ,vegan diet ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Introduction: The 2019 American College of Cardiology/American Heart Association (ACC/AHA) Prevention Guidelines emphasize reduction in dietary sodium, cholesterol, refined carbohydrates, saturated fat and sweetened beverages. We hypothesized that implementing this dietary pattern could reduce cardiovascular risk in a cohort of volunteers in an urban African American (AA) community church, during a 5-week ACC/AHA-styled nutrition intervention, assessed by measuring risk markers and adherence, called HEART-LENS (Helping Everyone Assess Risk Today Lenten Nutrition Study). Methods: The study population consisted of 53 volunteers who committed to eat only home-delivered non-dairy vegetarian meals (average daily calories 1155, sodium 1285 mg, cholesterol 0 mg; 58% carbohydrate, 17% protein, 25% fat). Body mass index (BMI) and fasting serum markers of cardiometabolic and risk factors were measured, with collection of any dietary deviation. Results: Of 53 volunteers, 44 (mean age 60.2 years, 37 women) completed the trial (88%); 1 was intolerant of the meals, 1 completed both blood draws but did not eat delivered food, and 7 did not return for the tests. Adherence to the diet was reported at 93% in the remaining 44. Cardiometabolic risk factors improved significantly, highlighted by a marked reduction in serum insulin (−43%, p = 0.000), hemoglobin A1c (6.2% to 6.0%, p = 0.000), weight and BMI (−10.2 lbs, 33 to 31 kg/m2, p = 0.000), but with small reductions of fasting glucose (−6%, p = 0.405) and triglyceride levels (−4%, p = 0.408). Additionally, improved were trimethylamine-N-oxide (5.1 to 2.9 µmol/L, −43%, p = 0.001), small dense low-density lipoprotein cholesterol (LDL) (24.2 to 19.1 mg/dL, −21%, p = 0.000), LDL (121 to 104 mg/dL, −14%, p = 0.000), total cholesterol (TC) (190 to 168 mg/dL, −12%, p = 0.000), and lipoprotein (a) (LP(a)) (56 to 51 mg/dL, −11%, p = 0.000); high sensitivity C-reactive protein (hs-CRP) was widely variable but reduced by 16% (2.5 to 2.1 ng/mL, p = NS) in 40 subjects without inflammatory conditions. Soluble urokinase plasminogen activator (suPAR) levels were not significantly changed. The ACC/AHA pooled cohort atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated for 41 and 36 volunteers, respectively, as the ASCVD risk could not be calculated for 3 subjects with low lipid fractions at baseline and 8 subjects after intervention (p = 0.184). In the remaining subjects, the mean 10-year risk was reduced from 10.8 to 8.7%, a 19.4% decrease (p = 0.006), primarily due to a 14% decrease in low-density lipoprotein cholesterol and a 10 mm Hg (6%) reduction in systolic blood pressure. Conclusions: In this prospective 5-week non-dairy vegetarian nutrition intervention with good adherence consistent with the 2019 ACC/AHA Guidelines in an at-risk AA population, markers of cardiovascular risk, cardiometabolism, and body weight were significantly reduced, including obesity, low-density lipoprotein cholesterol (LDLc) density, LP(a), inflammation, and ingestion of substrates mediating production of trimethylamine-N-oxide (TMAO). Albeit reduced, hs-CRP and suPAR, were not lowered consistently. This induced a significant decrease in the 10-year ASCVD risk in this AA cohort. If widely adopted, this could dramatically reduce and possibly eradicate, the racial disparity in ASCVD events and mortality, if 19% of the 21% increase is eliminated by this lifestyle change.
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- 2021
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8. Awareness and practice of aerobic exercise and yoga among hypertensive patients in Anand city
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Nirav Vaghela, Daxa Mishra, Jigar N Mehta, Hemal Punjabi, Hena Patel, and Ishani Sanchala
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aerobic exercise ,asanas ,awareness and practice ,blood pressure ,hypertension ,yoga ,Special aspects of education ,LC8-6691 ,Public aspects of medicine ,RA1-1270 - Abstract
BACKGROUND: Aerobic exercise is helpful in reducing elevated blood pressure (BP). It was also found that yoga is useful in reducing raised BP. Thus, they both can be used in prevention and treatment of hypertension. Hence, the study aimed to observe both awareness and practice of aerobic exercise and yoga among hypertensive patients in Anand city. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted. A questionnaire was prepared containing 24 questions about awareness and practice of aerobic exercise and yoga among hypertensive patients. The questions were explained to all the patients, and 200 patients were recruited from Anand city through convenience sampling. RESULTS: Two-hundred patients were included in this study, of which 100% were aware of hypertension. 67.68% were aware of the role of aerobic exercise in hypertension, of which 58.29% practiced them. The awareness of the role of yoga in hypertension was noted in 33.67% of patients, of which only 13.07% practiced pranayama and 9.50% practiced asanas. CONCLUSION: There was a complete awareness of hypertension among hypertensive patients. A large number of patients were aware of the role of aerobic exercise in hypertension, but only few of the patients practiced them. However, there was less awareness of the role of yoga in hypertension and even lesser number practiced them.
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- 2019
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9. Non-invasive diagnosis of transthyretin cardiac amyloidosis utilizing typical late gadolinium enhancement pattern on cardiac magnetic resonance and light chains
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Jeremy A Slivnick, Nazia Alvi, Cristiane C Singulane, Seth Scheetz, Akash Goyal, Hena Patel, Nitasha Sarswat, Karima Addetia, Fabio Fernandes, Marcelo Luiz Campos Vieira, Caio Rebouças Fonseca Cafezeiro, Suênia Freitas Carvalhal, Orlando P Simonetti, Jai Singh, Roberto M Lang, Karolina M Zareba, and Amit R Patel
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Aims While cardiac magnetic resonance (CMR) is often obtained early in the evaluation of suspected cardiac amyloidosis (CA), it currently cannot be utilized to differentiate immunoglobulin (AL) and transthyretin (ATTR) CA. We aimed to determine whether a novel CMR and light-chain biomarker-based algorithm could accurately diagnose ATTR-CA. Methods and results Patients with confirmed AL or ATTR-CA with typical late gadolinium enhancement (LGE) and Look-Locker pattern for CA on CMR were retrospectively identified at three academic medical centres. Comprehensive light-chain analysis including free light chains, serum, and urine electrophoresis/immunofixation was performed. The diagnostic accuracy of the typical CMR pattern for CA in combination with negative light chains for the diagnosis of ATTR-CA was determined both in the entire cohort and in the subset of patients with invasive tissue biopsy as the gold standard. A total of 147 patients (age 70 ± 11, 76% male, 51% black) were identified: 89 ATTR-CA and 58 AL-CA. Light-chain biomarkers were abnormal in 81 (55%) patients. Within the entire cohort, the sensitivity and specificity of a typical LGE and Look-Locker CMR pattern and negative light chains for ATTR-CA was 73 and 98%, respectively. Within the subset with biopsy-confirmed subtype, the CMR and light-chain algorithm were 69% sensitive and 98% specific. Conclusion The combination of a typical LGE and Look-Locker pattern on CMR with negative light chains is highly specific for ATTR-CA. The successful non-invasive diagnosis of ATTR-CA using CMR has the potential to reduce diagnostic and therapeutic delays and healthcare costs for many patients.
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- 2023
10. Relation of Myocardial Perfusion Reserve and Left Ventricular Ejection Fraction in Ischemic and Nonischemic Cardiomyopathy
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Shuo Wang, Hena Patel, Tamari Miller, Keith Ameyaw, Patrick Miller, Akhil Narang, Keigo Kawaji, Amita Singh, Luis Landeras, Xing-Peng Liu, Victor Mor-Avi, and Amit R. Patel
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Male ,Vasodilator Agents ,Magnetic Resonance Imaging, Cine ,Stroke Volume ,Coronary Artery Disease ,Middle Aged ,Ventricular Function, Left ,Article ,Perfusion ,Ischemia ,Coronary Circulation ,Humans ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Quantification of myocardial perfusion reserve (MPR) using vasodilator stress cardiac magnetic resonance is increasingly used to detect coronary artery disease. However, MPR can also be altered because of changes in microvascular function. We aimed to determine whether MPR can distinguish between ischemic cardiomyopathy (IC) secondary to coronary artery disease and non-IC (NIC) with microvascular dysfunction and no underlying epicardial coronary disease. A total of 60 patients (mean age 65 ± 14 years, 30% women), including 31 with IC and 29 with NIC, were identified from a pre-existing vasodilator stress cardiac magnetic resonance registry. Short-axis cine slices were used to measure left ventricular ejection fraction (LVEF) using the Simpson method of disks. MPR index (MPRi) was determined from first-pass myocardial perfusion images during stress and rest using the upslope ratio, normalized for the arterial input and corrected for rate pressure product. Patients in both groups were divided into subgroups of LVEF ≤35% and LVEF >35%. Differences in MPRi between the subgroups were examined. MPRi was moderately correlated with LVEF in patients with NIC (r = 0.53, p = 0.03), whereas the correlation in patients with IC was lower (r = 0.32, p = 0.22). Average LVEF in NIC and IC was 34% ± 8% and 35% ± 8%, respectively (p = 0.63). MPRi was not significantly different in IC compared with NIC (1.17 [0.88 to 1.61] vs 1.23 [1.07 to 1.66], p = 0.41), including the subgroups of LVEF (IC: 1.20 ± 0.56 vs NIC: 1.15 ± 0.24, p = 0.75 for LVEF ≤35% and IC: 1.35 ± 0.44 vs NIC: 1.58 ± 0.50, p = 0.19 for LVEF >35%). However, MPRi was significantly lower in patients with LVEF ≤35% compared with those with LVEF>35% (1.17 ± 0.40 vs 1.47 ± 0.47, p = 0.01). Similar difference between LVEF groups was noted in the patients with NIC (1.15 ± 0.24 vs 1.58 ± 0.50, p = 0.006) but not in the patients with IC (1.20 ± 0.56 vs 1.35 ± 0.44, p = 0.42). MPRi can be abnormal in the presence of left ventricular dysfunction with nonischemic etiology. This is a potential pitfall to consider when using this approach to detect ischemia because of epicardial coronary disease using myocardial perfusion imaging.
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- 2022
11. AI Based CMR Assessment of Biventricular Function
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Amit R. Patel, Roberto M. Lang, Keigo Kawaji, Akhil Narang, Xing-Peng Liu, Tamari Miller, Keith Ameyaw, Shuo Wang, Simran Anand, Stephanie A. Besser, Daksh Chauhan, Hena Patel, Emeka Anyanwu, and Victor Mor-Avi
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Cardiac function curve ,medicine.medical_specialty ,Ejection fraction ,Vasodilator stress ,Ventricular function ,business.industry ,Right ventricular ejection fraction ,Biventricular function ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Clinical significance ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives The aim of this study was to determine whether left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) and left ventricular mass (LVM) measurements made using 3 fully automated deep learning (DL) algorithms are accurate and interchangeable and can be used to classify ventricular function and risk-stratify patients as accurately as an expert. Background Artificial intelligence is increasingly used to assess cardiac function and LVM from cardiac magnetic resonance images. Methods Two hundred patients were identified from a registry of individuals who underwent vasodilator stress cardiac magnetic resonance. LVEF, LVM, and RVEF were determined using 3 fully automated commercial DL algorithms and by a clinical expert (CLIN) using conventional methodology. Additionally, LVEF values were classified according to clinically important ranges: Results Excellent correlations were seen for each DL-LVEF compared with CLIN-LVEF (r = 0.83-0.93). Good correlations were present between DL-LVM and CLIN-LVM (r = 0.75-0.85). Modest correlations were observed between DL-RVEF and CLIN-RVEF (r = 0.59-0.68). A >10% error between CLIN and DL ejection fraction was present in 5% to 18% of cases for the left ventricle and 23% to 43% for the right ventricle. LVEF classification agreed with CLIN-LVEF classification in 86%, 80%, and 85% cases for the 3 DL-LVEF approaches. There were no differences among the 4 approaches in associations with major adverse cardiovascular events for LVEF, LVM, and RVEF. Conclusions This study revealed good agreement between automated and expert-derived LVEF and similarly strong associations with outcomes, compared with an expert. However, the ability of these automated measurements to accurately classify left ventricular function for treatment decision remains limited. DL-LVM showed good agreement with CLIN-LVM. DL-RVEF approaches need further refinements.
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- 2022
12. Arrhythmias in Pregnancy
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Kamala P, Tamirisa, Uri, Elkayam, Joan E, Briller, Pamela K, Mason, Jayasree, Pillarisetti, Faisal M, Merchant, Hena, Patel, Dhanunjaya R, Lakkireddy, Andrea M, Russo, Annabelle Santos, Volgman, and Marmar, Vaseghi
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Flecainide ,Pregnancy ,Tachycardia ,Atrial Fibrillation ,Sotalol ,Humans ,Female ,Anti-Arrhythmia Agents - Abstract
Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a greater risk of arrhythmias, and patients with a history of arrhythmias are at significant risk of arrhythmia recurrence during pregnancy. The incidence of atrial fibrillation in pregnancy is rising. This review discusses the management of tachyarrhythmias and bradyarrhythmias in pregnancy, including management of cardiac arrest. Management of fetal arrhythmias are also reviewed. For patients without structural heart disease, β-blocker therapy, especially propranolol and metoprolol, and antiarrhythmic drugs, such as flecainide and sotalol, can be safely used to treat tachyarrhythmias. As a last resort, catheter ablation with minimal fluoroscopy can be performed. Device implantation can be safely performed with minimal fluoroscopy and under echocardiographic or ultrasound guidance in patients with clear indications for devices during pregnancy. Because of rising maternal mortality in the United States, which is partly driven by increasing maternal age and comorbidities, a multidisciplinary and/or integrative approach to arrhythmia management from the prepartum to the postpartum period is needed.
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- 2022
13. Women in Cardiology: Role of Social Media in Advocacy
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Annabelle Santos Volgman and Hena Patel
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0301 basic medicine ,medicine.medical_specialty ,Career Choice ,business.industry ,Field (Bourdieu) ,Cardiology ,General Medicine ,Physicians, Women ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Health care ,medicine ,Humans ,Women's Rights ,Female ,Social media ,Cardiology and Cardiovascular Medicine ,business ,Social Media ,Healthcare providers - Abstract
Digital and social media have transformed the field of medicine. They are powerful tools that academic and non-academic physicians and healthcare providers are using to influence others, promote ideas, obtain knowledge, disseminate research and communicate with others. The history of advocacy for women in medicine and the role of social media in influencing the choice of women to choose Cardiology as a career and its role in advocacy for Women in Cardiology (WIC) have been reviewed. It has changed the way cardiologists learn, educate, and interact with each other. Social media has proven especially useful in advocating for WIC, but whether it can help improve the numbers of female doctors going into Cardiology remains to be seen. In addition to encouraging women to pursue cardiology, social media has drawn attention to key women’s rights issues affecting practicing female cardiologists.
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- 2021
14. Effects of High-Sucrose, High-Fat, and High-Sodium Diets on Female Drosophila melanogaster Fertility and Health
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Hena Patel and Daniela Drummond-Barbosa
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General Medicine ,General Chemistry - Abstract
The obesity epidemic has become a global concern, affecting millions of people. Plummeting global fertility rates indicate a correlation between obesity and infertility, an issue that will likely worsen as the prevalence of maternal obesity rises. The effects of diet can be studied in Drosophila melanogaster, an ideal multicellular model with reproductive processes similar to those of humans. Obesity caused by diets rich in sucrose, sodium, or fat is known to negatively impact Drosophila health, decreasing egg production, shortening lifespan, and even causing transgenerational effects. Conversely, exercise may have beneficial outcomes on female Drosophila that are producing eggs, and its transgenerational effects are yet to be explored. By focusing future studies on female Drosophila affected by a combined diet, results will better replicate a Western diet consumed by women today. This literature review summarizes previous research correlating diet with detrimental effects on health and fertility to better understand the effects of a combined high-fat, sucrose, and sodium diet on female Drosophila. Additionally, this paper explains potential experimentation methods to implement in future studies to improve understanding of diet and fertility in Drosophila and its connotations to human diet and modern-day health.
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- 2022
15. Prognostic value of cardiac magnetic resonance septal late gadolinium enhancement patterns for periaortic ventricular tachycardia ablation: Heterogeneity of the anteroseptal substrate in nonischemic cardiomyopathy
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Roderick Tung, Cevher Ozcan, Amit R. Patel, Gaurav A. Upadhyay, Shuo Wang, Takuro Nishimura, Dalise Y. Shatz, Hena Patel, Hemal M. Nayak, and Heather L. Smith
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Gadolinium ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Article ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Physiology (medical) ,Internal medicine ,Heart Septum ,medicine ,Humans ,Late gadolinium enhancement ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Myocardium ,Magnetic resonance imaging ,Middle Aged ,Prognosis ,medicine.disease ,Ablation ,Nonischemic cardiomyopathy ,embryonic structures ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance - Abstract
BACKGROUND: Ventricular tachycardia (VT) from the anteroseptal subtype of nonischemic cardiomyopathy has a high probability of recurrence after catheter ablation. OBJECTIVE: The purpose of this study was to determine the predictive value of septal scar patterns by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) on ablation outcomes in patients with VT arising from an anteroseptal substrate. METHODS: Patients with periaortic VT arising from an anteroseptal substrate with preprocedural wideband LGE-CMR were divided into 2 groups by the degree of longitudinal septal LGE extension as full-length septal (≥80% anteroposterior length) or partial septal (
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- 2021
16. Impact of Wideband Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging on Device‐Related Artifacts in Different Implantable <scp>Cardioverter‐Defibrillator</scp> Types
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Roberto M. Lang, Hena Patel, Nazia Alvi, Amita Singh, Victor Mor-Avi, Jiangang Zou, Wensu Chen, Roderick Tung, Stephanie A. Besser, Amit R. Patel, and Keigo Kawaji
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medicine.medical_treatment ,Population ,Contrast Media ,Gadolinium ,Ventricular tachycardia ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Interquartile range ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,education ,Retrospective Studies ,Artifact (error) ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Implantable cardioverter-defibrillator ,medicine.disease ,Magnetic Resonance Imaging ,Defibrillators, Implantable ,medicine.anatomical_structure ,Ventricle ,Heart failure ,embryonic structures ,Artifacts ,business ,Nuclear medicine - Abstract
BACKGROUND Late gadolinium enhancement (LGE) imaging in patients with implantable cardioverter-defibrillators (ICD) is limited by device-related artifacts (DRA). The use of wideband (WB) LGE protocols improves LGE images, but their efficacy with different ICD types is not well known. PURPOSE To assess the effects of WB LGE imaging on DRA in different non-MR conditional ICD subtypes. STUDY TYPE Retrospective. POPULATION A total of 113 patients undergoing cardiac magnetic resonance imaging with three ICD subtypes: transvenous (TV-ICD, N = 48), cardiac-resynchronization therapy device (CRT-D, N = 48), and subcutaneous (S-ICD, N = 17). FIELD STRENGTH/SEQUENCE 5 T scanner, standard LGE, and WB LGE imaging with a phase-sensitive inversion recovery segmented gradient echo sequence. ASSESSMENT DRA burden was defined as the number of artifact-positive short-axis LGE slices as percentage of the total number of short-axis slices covering the left ventricle from based to apex, and was determined for WB and standard LGE studies for each patient. Additionally, artifact area on each slice was quantified. STATISTICAL TESTS Shapiro-Wilks, Kruskal-Wallis analysis of variance, Dunn tests with Bonferroni correction, and Mann-Whitney U-test. RESULTS In patients with TV-ICD, DRA burden was significantly reduced and nearly eliminated with WB LGE compared to standard LGE imaging (median [interquartile range]: 0 [0-7]% vs. 18 [0-50]%, P
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- 2021
17. PROGNOSTIC VALUE OF CMR ESTIMATED DIASTOLIC FUNCTION: A COMPARISON OF LEFT VENTRICULAR FILLING PRESSURES VERSUS LEFT ATRIAL VOLUME
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Jonathan A. Pan, Shuo Wang, Connor Wolff, Hena Patel, Jeremy Slivnick, Patrick Norton, Christopher M. Kramer, and Amit R. Patel
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Cardiology and Cardiovascular Medicine - Published
- 2023
18. Dietary Protein and Its Associations with Cardiovascular Health
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Koushik Reddy, Andrew M. Freeman, Robert Ostfeld, Karen Aspry, Kathleen Allen, James O'Keefe, Dean Ornish, Travis Batts, Monica Aggarwal, Beth White, Hena Patel, Elizabeth Klodas, Susan Levin, Dae Hyun Lee, and Kim A. Williams
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An adequate intake of dietary protein is critical to human health and, as a result, protein is the only macronutrient with a recommended daily allowance. Yet, compared to fat and carbohydrate sources, the impact of dietary protein sources on human and cardiovascular health has received far less attention. However, consistent data from large prospective cohort studies from the United States, Europe, and Asia have consistently documented reduced risk of ischemic heart disease (IHD) in individuals with the highest consumption of plant proteins, and an increased risk of IHD in those with the highest intake of animal proteins. Which cardiovascular disease (CVD) risk factors are most impacted is less clear. Mechanistic studies are limited by the fact that, like other macronutrients, protein in the human diet comes from a myriad of sources with varying proportions of non-protein micro and macronutrients that have independent influences on the development of atherosclerotic cardiovascular disease (ASCVD). However, growing evidence suggests that both non-protein and protein components of plant vs. animal protein sources may confer ASCVD protection or risk, and that inflammation and the gut microbiome play crucial roles.
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- 2022
19. Contemporary Management of Severe Acute Kidney Injury and Refractory Cardiorenal Syndrome
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Samuel B Brusca, David A. Morrow, Kianoush Kashani, Amir Kazory, John A. Kellum, Azra Bihorac, Sean van Diepen, Gaspar Del Rio-Pertuz, Michael A Mao, Aniket S Rali, Hena Patel, Michael A. Solomon, Jacob C. Jentzer, and Brad Moriyama
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,Cardiorenal syndrome ,Disease ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Epidemiology ,medicine ,Intravascular volume status ,Coronary care unit ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Dialysis - Abstract
Acute kidney injury (AKI) and cardiorenal syndrome (CRS) are increasingly prevalent in hospitalized patients with cardiovascular disease and remain associated with poor short- and long-term outcomes. There are no specific therapies to reduce mortality related to either AKI or CRS, apart from supportive care and volume status management. Acute renal replacement therapies (RRTs), including ultrafiltration, intermittent hemodialysis, and continuous RRT are used to manage complications of medically refractory AKI and CRS and may restore normal electrolyte, acid-base, and fluid balance before renal recovery. Patients who require acute RRT have a significant risk of mortality and long-term dialysis dependence, emphasizing the importance of appropriate patient selection. Despite the growing use of RRT in the cardiac intensive care unit, there are few resources for the cardiovascular specialist that integrate the epidemiology, diagnostic workup, and medical management of AKI and CRS with an overview of indications, multidisciplinary team management, and transition off of RRT.
- Published
- 2020
20. A Clinical Challenge Overcome by His Bundle Pacing
- Author
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Parikshit S. Sharma, Annabelle Santos Volgman, Tochukwu M. Okwuosa, Hena Patel, and Alison Zimmerman
- Subjects
0301 basic medicine ,Electroanatomic mapping ,medicine.medical_specialty ,RBBB - Right bundle branch block ,medicine.medical_treatment ,electrocardiography ,Cardiac resynchronization therapy ,HB, His bundle ,cardiac resynchronization therapy ,030105 genetics & heredity ,Cardiac pacemaker ,electroanatomic mapping ,03 medical and health sciences ,ECG, electrocardiography ,0302 clinical medicine ,RBBB, right bundle branch block ,shortness of breath ,Internal medicine ,medicine ,Mini-Focus Issue: Electrophysiology ,Diseases of the circulatory (Cardiovascular) system ,Exertion ,medicine.diagnostic_test ,business.industry ,AV, atrioventricular ,medicine.disease ,electrophysiology ,HBP, His bundle pacing ,Bundle ,RC666-701 ,Cardiology ,Case Report: Clinical Case ,Cardiology and Cardiovascular Medicine ,business ,RV, right ventricular ,Atrioventricular block ,Electrocardiography ,030217 neurology & neurosurgery ,cardiac pacemaker - Abstract
We highlight a diagnostic challenge in a patient with dyspnea on exertion due to radiation therapy–induced severe first-degree atrioventricular block and how permanent His bundle pacing was helpful in overcoming these symptoms. (Level of Difficulty: Intermediate.), Graphical abstract, This case highlights a diagnostic challenge in a patient with dyspnea on exertion due to radiation therapy–induced severe first-degree…
- Published
- 2020
21. Normal Values of Aortic Root Size According to Age, Sex and Race: Results of the World Alliance of Societies of Echocardiography Study
- Author
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Vivekanandan Amuthan, Pedro Gutierrez Fajardo, Masao Daimon, Ana Clara Tude Rodrigues, Michael Blankenhagen, Tatsuya Miyoshi, Edwin S. Tucay, Ravi R Kasliwal, Wendy Tsang, Hena Patel, Roberto M. Lang, Markus Degel, Denisa Muraru, Masaaki Takeuchi, Yun Zhang, Karima Addetia, Seung Woo Park, Kofo O. Ogunyankin, Anita Sadeghpour, Wase Investigators, Victor Mor-Avi, Federico M. Asch, Niklas Hitschrich, Marcus Schreckenberg, Rodolfo Citro, Gregory M. Scalia, James N. Kirkpatrick, Mark J. Monaghan, Ricardo E. Ronderos, Patel, H, Miyoshi, T, Addetia, K, Citro, R, Daimon, M, Gutierrez Fajardo, P, Kasliwal, R, Kirkpatrick, J, Monaghan, M, Muraru, D, Ogunyankin, K, Park, S, Ronderos, R, Sadeghpour, A, Scalia, G, Takeuchi, M, Tsang, W, Tucay, E, Tude Rodrigues, A, Amuthan, V, Zhang, Y, Schreckenberg, M, Blankenhagen, M, Degel, M, Hitschrich, N, Mor-Avi, V, Asch, F, and Lang, R
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Aortic root ,Normal values ,White People ,Article ,2D echocardiography ,Race (biology) ,Young Adult ,Reference Values ,Internal medicine ,medicine.artery ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiac skeleton ,Aorta ,Aged ,Body surface area ,business.industry ,Sinotubular Junction ,Racial Groups ,Middle Aged ,medicine.disease ,Echocardiography ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Aortic root dimension ,Kidney disease - Abstract
Background Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Using data from the World Alliance Societies of Echocardiography study, the authors sought to establish normal ranges of aortic dimensions across sexes, races, and a wide range of ages. Methods Adult individuals free of heart, lung, and kidney disease were prospectively enrolled from 15 countries, with even distributions among sexes and age groups: young (18–40 years), middle aged (41–65 years) and old (>65 years). Transthoracic two-dimensional echocardiograms of 1,585 subjects (mean age, 47 ± 17 years; 50.4% men; mean body surface area [BSA], 1.77 ± 0.22 m2) were analyzed in a core laboratory following American Society of Echocardiography guidelines. Measurements, indexed separately by BSA and by height, included the aortic annulus, sinuses of Valsalva, and sinotubular junction. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests. Results All aortic root dimensions were larger in men compared with women. After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared with the guidelines. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA or height adjustment. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. Conclusions There are significant differences in aortic dimensions according to sex, age, and race. Thus, current guideline-recommended normal ranges may need to be adjusted to account for these differences.
- Published
- 2021
22. Heal Thyself to Heal and Cure: Voices of Women in Cardiology
- Author
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Christina Cardy, Sherry-Ann Brown, Jane A. Linderbaum, Ami B. Bhatt, Gina Lundberg, Kamala P Tamirisa, Laxmi S. Mehta, Marci Farquhar-Snow, Smadar Kort, and Hena Patel
- Subjects
burnout ,COVID-19, coronavirus disease-2019 ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Voices in Cardiology ,COVID-19 ,Burnout ,Viewpoint ,Nursing ,well-being ,self-care ,WHO, World-Health Organization ,PPE-Personal protective equipment ,Self care ,Medicine ,ACC, American College of Cardiology ,Cardiology and Cardiovascular Medicine ,business ,PPE, personal protective equipment - Published
- 2021
23. Nutrition Intervention for Reduction of Cardiovascular Risk in African Americans Using the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines
- Author
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Jochen Reiser, Hena Patel, Kim A. Williams, Monica Mazur, Ibtihaj Fughhi, Setri Fugar, Sharon Gates, Darrius Chambers, Ronald McDaniel, Stephen Sawyer, and Terry Mason
- Subjects
cardiovascular risk ,Male ,medicine.medical_specialty ,Saturated fat ,Population ,Guidelines as Topic ,Article ,chemistry.chemical_compound ,Eating ,Internal medicine ,Early Medical Intervention ,medicine ,Early Intervention, Educational ,Humans ,TX341-641 ,education ,Aged ,African Americans ,education.field_of_study ,Nutrition and Dietetics ,Triglyceride ,Cholesterol ,business.industry ,Nutrition. Foods and food supply ,Vegetarian nutrition ,vegan diet ,Middle Aged ,medicine.disease ,Obesity ,United States ,nutrition intervention ,Diet ,Black or African American ,Primary Prevention ,chemistry ,plant-based diet ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Cardiology ,Female ,business ,Body mass index ,Biomarkers ,Food Science ,Blood drawing - Abstract
Introduction: The 2019 American College of Cardiology/American Heart Association (ACC/AHA) Prevention Guidelines emphasize reduction in dietary sodium, cholesterol, refined carbohydrates, saturated fat and sweetened beverages. We hypothesized that implementing this dietary pattern could reduce cardiovascular risk in a cohort of volunteers in an urban African American (AA) community church, during a 5-week ACC/AHA-styled nutrition intervention, assessed by measuring risk markers and adherence, called HEART-LENS (Helping Everyone Assess Risk Today Lenten Nutrition Study). Methods: The study population consisted of 53 volunteers who committed to eat only home-delivered non-dairy vegetarian meals (average daily calories 1155, sodium 1285 mg, cholesterol 0 mg, 58% carbohydrate, 17% protein, 25% fat). Body mass index (BMI) and fasting serum markers of cardiometabolic and risk factors were measured, with collection of any dietary deviation. Results: Of 53 volunteers, 44 (mean age 60.2 years, 37 women) completed the trial (88%), 1 was intolerant of the meals, 1 completed both blood draws but did not eat delivered food, and 7 did not return for the tests. Adherence to the diet was reported at 93% in the remaining 44. Cardiometabolic risk factors improved significantly, highlighted by a marked reduction in serum insulin (−43%, p = 0.000), hemoglobin A1c (6.2% to 6.0%, p = 0.000), weight and BMI (−10.2 lbs, 33 to 31 kg/m2, p = 0.000), but with small reductions of fasting glucose (−6%, p = 0.405) and triglyceride levels (−4%, p = 0.408). Additionally, improved were trimethylamine-N-oxide (5.1 to 2.9 µmol/L, −43%, p = 0.001), small dense low-density lipoprotein cholesterol (LDL) (24.2 to 19.1 mg/dL, −21%, p = 0.000), LDL (121 to 104 mg/dL, −14%, p = 0.000), total cholesterol (TC) (190 to 168 mg/dL, −12%, p = 0.000), and lipoprotein (a) (LP(a)) (56 to 51 mg/dL, −11%, p = 0.000), high sensitivity C-reactive protein (hs-CRP) was widely variable but reduced by 16% (2.5 to 2.1 ng/mL, p = NS) in 40 subjects without inflammatory conditions. Soluble urokinase plasminogen activator (suPAR) levels were not significantly changed. The ACC/AHA pooled cohort atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated for 41 and 36 volunteers, respectively, as the ASCVD risk could not be calculated for 3 subjects with low lipid fractions at baseline and 8 subjects after intervention (p = 0.184). In the remaining subjects, the mean 10-year risk was reduced from 10.8 to 8.7%, a 19.4% decrease (p = 0.006), primarily due to a 14% decrease in low-density lipoprotein cholesterol and a 10 mm Hg (6%) reduction in systolic blood pressure. Conclusions: In this prospective 5-week non-dairy vegetarian nutrition intervention with good adherence consistent with the 2019 ACC/AHA Guidelines in an at-risk AA population, markers of cardiovascular risk, cardiometabolism, and body weight were significantly reduced, including obesity, low-density lipoprotein cholesterol (LDLc) density, LP(a), inflammation, and ingestion of substrates mediating production of trimethylamine-N-oxide (TMAO). Albeit reduced, hs-CRP and suPAR, were not lowered consistently. This induced a significant decrease in the 10-year ASCVD risk in this AA cohort. If widely adopted, this could dramatically reduce and possibly eradicate, the racial disparity in ASCVD events and mortality, if 19% of the 21% increase is eliminated by this lifestyle change.
- Published
- 2021
24. Cardiac Sarcoidosis
- Author
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Amit R. Patel and Hena Patel
- Subjects
medicine.medical_specialty ,business.industry ,Cardiac sarcoidosis ,medicine.disease ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Cardiology ,Medicine ,Late gadolinium enhancement ,Radiology, Nuclear Medicine and imaging ,Sarcoidosis ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
25. The diagnostic and prognostic utility of risk factors defined by the AHA/ACCF on the evaluation of cardiac disease in liver transplantation candidates
- Author
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Edie Y. Chan, Rami Doukky, Meron Teshome, Sarah Alexander, and Hena Patel
- Subjects
Adult ,Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Heart Diseases ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Liver transplantation ,Left ventricular hypertrophy ,Risk Assessment ,Severity of Illness Index ,Coronary artery disease ,Decision Support Techniques ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Diagnosis ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Retrospective Studies ,Transplantation ,business.industry ,Patient Selection ,Hazard ratio ,Reproducibility of Results ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Cardiac surgery ,Liver Transplantation ,Liver ,lcsh:RC666-701 ,Asymptomatic Diseases ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Research Article - Abstract
Background The diagnostic and prognostic utility of risk factors proposed by the 2012 American Heart Association and American College of Cardiology Foundation (AHA/ACCF) Scientific Statement on the cardiac assessment of asymptomatic liver transplantation candidates have not been validated. We investigated whether the sum of risk factors proposed by the AHA/ACCF can identify liver transplant candidates at increased cardiac risk. Methods In a retrospective cohort of consecutive liver transplantation recipients, we calculated, for each subject, the pre-transplantation sum of AHA/ACCF risk factors (age > 60 years, prior cardiovascular disease, hypertension, dyslipidemia, diabetes mellitus, smoking, and left ventricular hypertrophy). The primary outcome was the presence of severe coronary artery disease (CAD), defined as ≥70% stenosis or ≥ 50% left main stenosis on pre-transplantation angiography. The secondary outcomes were the composite of cardiac death or myocardial infarction (MI) and the composite of cardiac death, MI, or coronary revascularization. Results Among 220 liver transplant recipients, the sum of AHA/ACCF risk factors had good discriminatory capacity for severe CAD [area under the curve, 0.77; 95% confidence interval (CI), 0.62–0.92; P = 0.007]; having ≥3 risk factors provided 75% sensitivity and 77% specificity for severe CAD. During mean post-transplantation follow-up of 48 ± 31 months, having ≥3 risk factors was associated with increased risk of the secondary composite outcomes of cardiac death or MI [hazard ratio, 2.39; P = 0.044] and cardiac death, MI, or coronary revascularization [hazard ratio, 2.39; P = 0.044]. Conclusions In patients undergoing cardiac assessment prior to liver transplantation, the sum of risk factors proposed by the AHA/ACCF provides significant diagnostic and prognostic utility. Having ≥3 AHA/ACCF risk factors is a reasonable threshold to prompt non-invasive stress testing in asymptomatic liver transplantation candidates.
- Published
- 2019
26. Contributors
- Author
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Beth L. Abramson, Niti R. Aggarwal, Jack Aguilar, Christina K. Anderson, Zoltan Arany, C. Noel Bairey Merz, Ami B. Bhatt, Laurie Bossory, Konstantinos Dean Boudoulas, Renee P. Bullock-Palmer, Sarah Chuzi, Daniela Crousillat, Anne B. Curtis, Esther Davis, Anita Deswal, Mariana Garcia, Eugenia Gianos, Ridhima Goel, Rajiv Gulati, Sonia A. Henry, Jeff C. Huffman, Sasha De Jesus, Deborah N. Kalkman, Cynthia Kos, Yamini Krishnamurthy, Gautam Kumar, Sonali Kumar, Benjamin Laliberte, Emily Lau, Ana Micaela León, Jennifer Lewey, Christina M. Luberto, Rekha Mankad, JoAnn E. Manson, Stephanie Trentacoste McNally, Roxana Mehran, Laxmi S. Mehta, Puja K. Mehta, Theofanie Mela, Erin D. Michos, Jennifer H. Mieres, Iva Minga, Anum Minhas, Selma F. Mohammed, Sharon L. Mulvagh, Ajith P. Nair, Anna O’Kelly, Tochi M. Okwuosa, Elyse R. Park, Hena Patel, Odayme Quesada, Stacey E. Rosen, Andrea M. Russo, Amy Sarma, Dawn C. Scantlebury, Nandita S. Scott, Ashish Sharma, Garima Sharma, Chrisandra Shufelt, Kajenny Srivaratharajah, Juan Tamargo, María Tamargo, Pamela Telisky, Marysia S. Tweet, Birgit Vogel, Annabelle Santos Volgman, Esther Vorovich, Janet Wei, Nanette K. Wenger, Clyde W. Yancy, Gloria Y. Yeh, Debbie C. Yen, and Evin Yucel
- Published
- 2021
27. CardioOncology
- Author
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Iva Minga, Hena Patel, Tochi M. Okwuosa, and Niti R. Aggarwal
- Published
- 2021
28. Abstract 16189: Cardiovascular Risk Prediction Using Fully Automated Artificial Intelligence Algorithms for the Assessment of Right Ventricular Function From Cardiac Magnetic Resonance Images
- Author
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Tamari Miller, Victor Mor-Avi, Keigo Kawaji, Akhil Narang, Patel R Amit, Qiang Tang, Daksh Chauhan, Keith Ameyaw, Shuo Wang, Hena Patel, and Stephanie A. Besser
- Subjects
Ventricular function ,Fully automated ,business.industry ,Physiology (medical) ,Measure (physics) ,Medicine ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance ,Cardiac imaging ,Right ventricular ejection fraction - Abstract
Background: It is unclear whether artificial intelligence (AI) can provide automatic solutions to measure right ventricular ejection fraction (RVEF), due to the complex RV geometry. Although several deep learning (DL) algorithms are available to quantify RVEF from cardiac magnetic resonance (CMR) images, there has been no systematic comparison of these algorithms, and the prognostic value of these automated measurements is unknown. We aimed to determine whether RVEF measurements made using DL algorithms could be used to risk stratify patients similarly to measurements made by an expert. Methods: We identified from a pre-existing registry 200 patients who underwent CMR. RVEF was determined using 3 fully automated commercial DL algorithms (DL-RVEF) and also by a clinical expert (CLIN-RVEF) using conventional methodology. Each of the DL-RVEF approaches was compared against CLIN-RVEF using linear regression and Bland-Altman analyses. In addition, RVEF values were classified according to clinically important cutoffs: Results: The CLIN-RVEF and the three DL-RVEFs were obtained in all patients. We found only modest correlations between DL-RVEF and CLIN-RVEF (figure). The DL-RVEF algorithms had accuracy ranging from 0.59 to 0.78 for categorizing RV function. Nevertheless, ROC analysis showed no significant differences between the 4 approaches in predicting MACE, as reflected by respective AUC values of 0.68, 0.69, 0.64 and 0.63. Conclusions: Although the automated algorithms predicted patient outcomes as well as the CLIN-RVEF, the agreement between DL-RVEF and the clinical expert’s measurements was not optimal. DL approaches need further refinements to improve automated assessment of RV function.
- Published
- 2020
29. Plant-Based Nutrition
- Author
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Kim Allan WilliamsSr. and Hena Patel
- Subjects
Heart disease ,business.industry ,Environmental health ,Incidence (epidemiology) ,Medicine ,Plant based ,Disease ,business ,Micronutrient ,Healthy diet ,medicine.disease ,Nutrition counseling ,Cause of death - Abstract
Despite improvements in cardiovascular mortality rates over the past several decades, cardiovascular disease (CVD) remains a leading cause of death in the USA. The rising prevalence of heart disease is strongly related to lifestyle factors. While a healthy diet is a well-established powerful tool for the prevention and treatment of CVD, nutrition counseling is insufficiently addressed by healthcare professionals, potentially from lack of education and awareness. Multiple studies have linked dietary patterns with incidence of CVD and found that consuming predominantly plant-based foods, versus animal-based, is associated with lower rates of heart disease. Plant-based dietary patterns are becoming increasingly popular because of a variety of reported health benefits to overall health and disease cardiovascular risk in particular.
- Published
- 2020
30. Overcoming left bundle branch block by permanent His bundle pacing: Evidence of longitudinal dissociation in the His via recordings from a permanent pacing lead
- Author
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Parikshit S. Sharma, Hena Patel, Richard G. Trohman, and Kristin Ellison
- Subjects
medicine.medical_specialty ,Left bundle branch block ,business.industry ,Split His ,Longitudinal dissociation ,Case Report ,030204 cardiovascular system & hematology ,medicine.disease ,Permanent His bundle pacing ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Bundle ,RC666-701 ,medicine ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,Longitudinal dissociation of HB ,Cardiology and Cardiovascular Medicine ,business ,Lead (electronics) ,030217 neurology & neurosurgery ,Intra-Hisian block - Published
- 2017
31. Normal Values of Cardiac Output and Stroke Volume According to Measurement Technique, Age, Sex, and Ethnicity: Results of the World Alliance of Societies of Echocardiography Study
- Author
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R.V.A. Ananth, Seung Woo Park, S. Balasubramanian, Tania Regina Afonso, Davide Di Vece, Marcus Schreckenberg, Luigi P. Badano, Tomoko Nakao, Ravi R Kasliwal, Amuthan Vivekanandan, Tatsuya Miyoshi, Federico M. Asch, Agatha Kwon, Babitha Thampinathan, Maala Sooriyakanthan, Azin Alizadehasl, Alexander Rossmanith, Hena Patel, Masaaki Takeuchi, Michael Blankenhagen, R. Alagesan, Michael P. Henry, Kofo O. Ogunyankin, Michele Bellino, Wendy Tsang, Gregory M. Scalia, Zhilong Wang, Aldo D. Prado, Pedro Gutierrez Fajardo, Ricardo E. Ronderos, Rodolfo Citro, Hye Rim Yun, Jiwon Hwang, Edwin S. Tucay, Karima Addetia, Yousuke Nabeshima, Megumi Hirokawa, Shuang Li, James N. Kirkpatrick, Roberto M. Lang, Masao Daimon, Takayuki Kawata, Markus Degel, Samantha Hoschke-Edwards, Tiangang Zhu, Victor Mor-Avi, Eduardo Filipini, Denisa Muraru, Yingbin Wang, Manish Bansal, Ana Clara Tude Rodrigues, Mark J. Monaghan, Lixue Yin, Eduardo Bossone, Naoko Sawada, Yun Zhang, Anita Sadeghpour, Patel, H, Miyoshi, T, Addetia, K, Henry, M, Citro, R, Daimon, M, Gutierrez Fajardo, P, Kasliwal, R, Kirkpatrick, J, Monaghan, M, Muraru, D, Ogunyankin, K, Park, S, Ronderos, R, Sadeghpour, A, Scalia, G, Takeuchi, M, Tsang, W, Tucay, E, Tude Rodrigues, A, Vivekanandan, A, Zhang, Y, Schreckenberg, M, Blankenhagen, M, Degel, M, Rossmanith, A, Mor-Avi, V, Asch, F, Lang, R, Prado, A, Filipini, E, Kwon, A, Hoschke-Edwards, S, Afonso, T, Thampinathan, B, Sooriyakanthan, M, Zhu, T, Wang, Z, Wang, Y, Yin, L, Li, S, Alagesan, R, Balasubramanian, S, Ananth, R, Bansal, M, Alizadehasl, A, Badano, L, Bossone, E, Di Vece, D, Bellino, M, Nakao, T, Kawata, T, Hirokawa, M, Sawada, N, Nabeshima, Y, Yun, H, and Hwang, J
- Subjects
Adult ,Male ,Cardiac output ,Cardiac function curve ,medicine.medical_specialty ,Adolescent ,Ethnic group ,Cardiac index ,Hemodynamics ,030204 cardiovascular system & hematology ,Article ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Reference Values ,Internal medicine ,Ethnicity ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ventricular function ,Body surface area ,business.industry ,Doppler ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Stroke volume ,Middle Aged ,medicine.disease ,Echocardiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Background Assessment of cardiac output (CO) and stroke volume (SV) is essential to understand cardiac function and hemodynamics. These parameters can be examined using three echocardiographic techniques (pulsed-wave Doppler, two-dimensional [2D], and three-dimensional [3D]). Whether these methods can be used interchangeably is unclear. The influence of age, sex, and ethnicity on CO and SV has also not been examined in depth. In this report from the World Alliance of Societies of Echocardiography Normal Values Study, the authors compare CO and SV in healthy adults according to age, sex, ethnicity, and measurement techniques. Methods A total of 1,450 adult subjects (53% men) free of heart, lung, and kidney disease were prospectively enrolled in 15 countries, with even distributions among age groups and sex. Subjects were divided into three age groups (young, 18–40 years; middle aged, 41–65 years; and old, >65 years) and three main racial groups (whites, blacks, and Asians). CO and SV were indexed (cardiac index [CI] and SV index [SVI], respectively) to body surface area and height and measured using three echocardiographic methods: Doppler, 2D, and 3D. Images were analyzed at two core laboratories (one each for 2D and 3D). Results CI and SVI were significantly lower by 2D compared with both Doppler and 3D methods in both sexes. SVI was significantly lower in women than men by all three methods, while CI differed only by 2D. SVI decreased with aging by all three techniques, whereas CI declined only with 2D and 3D. CO and SV were smallest in Asians and largest in whites, and the differences persisted after normalization for body surface area. Conclusions The present results provide normal reference values for CO and SV, which differ by age, sex, and race. Furthermore, CI and SVI measurements by the different echocardiographic techniques are not interchangeable. All these factors need to be taken into account when evaluating cardiac function and hemodynamics in individual patients.
- Published
- 2021
32. PERFORMANCE OF A NOVEL DEEP LEARNING-BASED MRI RECONSTRUCTION ALGORITHM TO IMPROVE MYOCARDIAL PERFUSION IMAGES
- Author
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Martin A. Janich, Haonan Wang, Donovan Gorre, Amit R. Patel, Shuo Wang, Hena Patel, and Paul Kim
- Subjects
business.industry ,Deep learning ,Medicine ,Computer vision ,Reconstruction algorithm ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Published
- 2021
33. CAN ASSESSMENT OF MYOCARDIAL PERFUSION RESERVE DIFFERENTIATE BETWEEN ISCHEMIC AND NON ISCHEMIC CARDIOMYOPATHY WITH REDUCED EJECTION FRACTION
- Author
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Akhil Narang, Keith Ameyaw, Shuo Wang, Tamari Miller, Amit R. Patel, Keigo Kawaji, Victor Mor-Avi, and Hena Patel
- Subjects
medicine.medical_specialty ,Ejection fraction ,business.industry ,Internal medicine ,medicine ,Cardiology ,Non ischemic cardiomyopathy ,Perfusion reserve ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
34. Narrowing the Disparities in Heart Failure
- Author
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Hena Patel and Kim A. Williams
- Subjects
medicine.medical_specialty ,business.industry ,Event (relativity) ,030204 cardiovascular system & hematology ,medicine.disease ,Health equity ,03 medical and health sciences ,0302 clinical medicine ,Heart failure ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2018
35. Sex Differences in Takotsubo Syndrome: A Narrative Review
- Author
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Arianne Clare Agdamag, Tisha Suboc, Anupama Rao, Hena Patel, Karolina Marinescu, Sonal Chandra, Annabelle Santos Volgman, and Clara Ledsky
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Cardiomyopathy ,Cochrane Library ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Takotsubo Cardiomyopathy ,medicine ,Illness severity ,Humans ,Takotsubo syndrome ,Mechanism (biology) ,business.industry ,Heart ,General Medicine ,medicine.disease ,030228 respiratory system ,Narrative review ,Female ,Presentation (obstetrics) ,Transthoracic echocardiogram ,business ,Cardiomyopathies ,030217 neurology & neurosurgery - Abstract
Takotsubo syndrome (TTS), or apical ballooning syndrome, is a transient and usually reversible form of cardiac dysfunction. It has classically been described in women with cardiac susceptibility when exposed to emotional or physical stress. Various hypotheses on the pathophysiology of TTS have been suggested, but the underlying mechanism remains unknown. There is increasing recognition of the sex differences in the presentation, triggers, severity, and complications of TTS. A literature review was conducted and found 75 relevant articles on PubMed Cochrane Library, and Google Scholar from 2001 to 2019 regarding TTS. We found remarkable sex differences existed in the underlying triggers, pathophysiology, illness severity, complications, and mortality. However, no sex differences were identified for baseline transthoracic echocardiogram findings, age at presentation, presenting symptoms, recurrence, and treatment approach. Much information regarding TTS remain lacking, but collaboration of national and international registries will be beneficial in addressing these gaps.
- Published
- 2019
36. Hypertension in older adults: Assessment, management, and challenges
- Author
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Setri Fugar, Hena Patel, Estefania Oliveros, Kim A. Williams, Alan Goldberg, Stella Kyung, and Nidhi Madan
- Subjects
Population ageing ,medicine.medical_specialty ,Aging ,hypertension ,Health Status ,Population ,Reviews ,Blood Pressure ,Review ,030204 cardiovascular system & hematology ,older adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Healthy Lifestyle ,Intensive care medicine ,education ,Stroke ,Aged ,Geriatrics ,Aged, 80 and over ,education.field_of_study ,geriatrics ,business.industry ,Public health ,Age Factors ,General Medicine ,medicine.disease ,antihypertensive agents ,blood pressure monitoring ,Treatment Outcome ,Heart failure ,Practice Guidelines as Topic ,Arterial stiffness ,Cardiology and Cardiovascular Medicine ,business ,Risk Reduction Behavior - Abstract
Hypertension in older adults is related to adverse cardiovascular outcomes, such as heart failure, stroke, myocardial infarction, and death. The global burden of hypertension is increasing due to an aging population and increasing prevalence of obesity, and is estimated to affect one third of the world's population by 2025. Adverse outcomes in older adults are compounded by mechanical hemodynamic changes, arterial stiffness, neurohormonal and autonomic dysregulation, and declining renal function. This review highlights the current evidence and summarizes recent guidelines on hypertension, pertaining to older adults. Management strategies for hypertension in older adults must consider the degree of frailty, increasingly complex medical comorbidities, and psycho‐social factors, and must therefore be individualized. Non‐pharmacological lifestyle interventions should be encouraged to mitigate the risk of developing hypertension, and as an adjunctive therapy to reduce the need for medications. Pharmacological therapy with diuretics, renin‐angiotensin system blockers, and calcium channel blockers have all shown benefit on cardiovascular outcomes in older patients. Given the economic and public health burden of hypertension in the United States and globally, it is critical to address lifestyle modifications in younger generations to prevent hypertension with age.
- Published
- 2019
37. Healthy Plant-Based Diet
- Author
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Hena Patel and Kim A. Williams
- Subjects
03 medical and health sciences ,0302 clinical medicine ,Traditional medicine ,business.industry ,Medicine ,Plant based ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
38. VALIDATION OF FULLY AUTOMATED DEEP LEARNING BASED ASSESSMENT OF LEFT VENTRICULAR EJECTION FRACTION FROM CARDIAC MAGNETIC RESONANCE IMAGES
- Author
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Hena Patel, Akhil Narang, Keigo Kawaji, Amit R. Patel, Victor Mor-Avi, Keith Ameyaw, Shuo Wang, and Miller Tamari
- Subjects
medicine.medical_specialty ,Ejection fraction ,Fully automated ,business.industry ,Internal medicine ,Deep learning ,cardiovascular system ,Cardiology ,Medicine ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance - Abstract
New deep learning (DL) algorithms for automated quantification of left ventricular (LV) ejection fraction (EF) from cardiac magnetic resonance (CMR) images need to be validated prior to clinical use. We hypothesized that a novel, fully automated DL algorithm can quantify EF as accurately as clinical
- Published
- 2020
39. Dietary Amino Acid Deficiency with a Restrictive Raw Vegan Diet: A Case of Orthorexia Nervosa: Lacking Lysine/Methionine Madness
- Author
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Hena Patel and Kim A. Williams
- Subjects
medicine.medical_specialty ,Methionine ,business.industry ,fungi ,Lysine ,Albumin ,food and beverages ,Vegan Diet ,medicine.disease ,Blood proteins ,chemistry.chemical_compound ,Endocrinology ,Dietary Amino Acid ,chemistry ,Internal medicine ,medicine ,business ,Orthorexia nervosa - Abstract
It is often stated that a plant-based diet can lead to protein deficiency, although this has never been reported with a well-balanced vegetarian diet. This case reports the results of a highly restrictive plant-based diet, which led to deficiencies in critical serum proteins with near fatal results. This was easily corrected by broadening the raw vegetarian components of the diet.
- Published
- 2020
40. Heart Centers for Women: Historical Perspective on Formation and Future Strategies to Reduce Cardiovascular Disease
- Author
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Sandra J. Lewis, Robert A. Harrington, Gina Lundberg, Hena Patel, Neelum T. Aggarwal, Rupa Sanghani, Lynne T. Braun, Niti R. Aggarwal, Annabelle Santos Volgman, Jennifer H. Mieres, Malissa J. Wood, and Laxmi S. Mehta
- Subjects
medicine.medical_specialty ,education ,Disease ,030204 cardiovascular system & hematology ,Ambulatory Care Facilities ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Medicine ,Humans ,030212 general & internal medicine ,Healthcare Disparities ,Curriculum ,Aged ,Patient care team ,Health professionals ,business.industry ,Delivery of Health Care, Integrated ,Perspective (graphical) ,Mortality reduction ,Health Status Disparities ,Middle Aged ,Prognosis ,Women's Health Services ,Cardiovascular Diseases ,Family medicine ,Women's Health ,Female ,Cardiology and Cardiovascular Medicine ,business ,Healthcare providers ,Diversity (business) - Abstract
Heart Centers for Women (HCW) developed as a response to the need for improved outcomes for women with cardiovascular disease (CVD). From 1984 until 2012, more women died of CVD every single year in comparison with men. Initially, there was limited awareness and sex-specific research regarding mortality or outcomes in women. HCW played an active role in addressing these disparities, provided focused care for women, and contributed to improvements in these gaps. In 2014 and 2015, death from CVD in women had declined below the level of death from CVD in comparison with men. Even though awareness of CVD in women has increased among the public and healthcare providers and both sex- and gender-specific research is currently required in all research trials, not all women have benefitted equally in mortality reduction. New strategies for HCW need to be developed to address these disparities and expand the current HCW model. The HCW care team needs to direct academic curricula on sex- and gender-specific research and care; expand to include other healthcare professionals and other subspecialties; provide new care models; address diversity; and include more male providers.
- Published
- 2018
41. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association
- Author
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Laxmi S. Mehta, Annabelle Santos Volgman, Hena Patel, Kevin S. Shah, Aruna V. Krishnan, Svati H. Shah, Abha Khandelwal, Judith H. Lichtman, Milan Gupta, Neelum T. Aggarwal, Karol E. Watson, Latha S. Palaniappan, and Stroke in Women
- Subjects
medicine.medical_specialty ,Health Status ,Vietnamese ,Population ,Ethnic group ,Emigrants and Immigrants ,Comorbidity ,030204 cardiovascular system & hematology ,Lower risk ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Asian People ,Indian Ocean Islands ,Risk Factors ,Physiology (medical) ,Epidemiology ,Asia, Western ,Prevalence ,medicine ,Humans ,East Asia ,030212 general & internal medicine ,education ,Life Style ,Socioeconomic status ,education.field_of_study ,Evidence-Based Medicine ,Asian Indian ,business.industry ,Incidence ,American Heart Association ,Atherosclerosis ,Prognosis ,Culturally Competent Care ,United States ,language.human_language ,language ,Cardiology and Cardiovascular Medicine ,business ,Demography - Abstract
South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the world’s population and are one of the fastest-growing ethnic groups in the United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD). South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Literature relevant to South Asian populations regarding demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies, is summarized. The evidence to date is that the biology of ASCVD is complex but is no different in South Asians than in any other racial/ethnic group. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially those related to insulin resistance, and no unique risk factors in this population have been found. This scientific statement focuses on how ASCVD risk factors affect the South Asian population in order to make recommendations for clinical strategies to reduce disease and for directions for future research to reduce ASCVD in this population.
- Published
- 2018
42. Fibrosing mediastinitis-related pulmonary artery and vein stenosis-limiting chemotherapy
- Author
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Tochukwu M. Okwuosa, Arianne Clare Agdamag, Hena Patel, and Michael Lawrenz Ferreras Co
- Subjects
medicine.medical_specialty ,Sternum ,Images In… ,medicine.medical_treatment ,Bone Neoplasms ,Breast Neoplasms ,Constriction, Pathologic ,Pulmonary Artery ,Metastasis ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine.artery ,medicine ,Humans ,Neoplasm Metastasis ,Vein ,Aged ,Chemotherapy ,Sclerosis ,business.industry ,Palliative Care ,Mediastinum ,General Medicine ,medicine.disease ,Stenosis ,Mediastinitis ,medicine.anatomical_structure ,Dyspnea ,030228 respiratory system ,Pulmonary Veins ,030220 oncology & carcinogenesis ,Pulmonary artery ,Female ,Radiology ,business ,Tomography, X-Ray Computed ,Mastectomy - Abstract
A 74-year-old woman presented for second opinion of dyspnoea management. Her medical history included breast cancer treated with mastectomy, doxorubicin, cyclophosphamide and tamoxifen. She developed recurrent metastatic disease in the mediastinum, managed with 89 six-week cycles of paclitaxel over 10 years that was well tolerated and effective in stabilising the disease initially but eventually discontinued due to new sternal metastasis diagnosed on imaging and increasing dyspnoea. Examination revealed diminished left-sided breath sounds. Routine labs were normal. Echocardiogram showed normal left ventricular function and dilated right chambers. Repeat chest CT demonstrated: (1) extensive calcification …
- Published
- 2018
43. The Cardiologist and the Cancer Patient: Challenges to Cardio-Oncology (or Onco-Cardiology) and Call to Action
- Author
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Tochi M, Okwuosa, Nicole, Prabhu, Hena, Patel, Timothy, Kuzel, Parameswaran, Venugopal, Kim A, Williams, and Agne, Paner
- Subjects
Cardiologists ,Cardiology ,Interdisciplinary Communication ,Medical Oncology - Published
- 2018
44. Sex Differences in Ischemic Heart Disease
- Author
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Annabelle Santos Volgman, Malissa J. Wood, Rupa Sanghani, Gina Lundberg, Jennifer H. Mieres, Hena Patel, Niti R. Aggarwal, Sandra J. Lewis, Marla A. Mendelson, and Laxmi S. Mehta
- Subjects
Male ,Gerontology ,Heredity ,Myocardial Ischemia ,Ethnic group ,Comorbidity ,Disease ,030204 cardiovascular system & hematology ,Risk Assessment ,Coronary artery disease ,03 medical and health sciences ,Age Distribution ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,Genetic Predisposition to Disease ,030212 general & internal medicine ,Healthcare Disparities ,Sex Distribution ,Risk factor ,Life Style ,Disease burden ,Aged ,Aged, 80 and over ,business.industry ,Incidence ,Age Factors ,Health Status Disparities ,Middle Aged ,Prognosis ,medicine.disease ,Educational attainment ,Health equity ,Disadvantaged ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled “Women’s Health Research—Progress, Pitfalls, and Promise,” highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex- and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.
- Published
- 2018
45. Advances in Cardiovascular Health in Women over the Past Decade: Guideline Recommendations for Practice
- Author
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Eileen Hsich, Annabelle Santos Volgman, Amparo C Villablanca, Hena Patel, Susan M. Campbell, and Pejman Raeisi-Giglou
- Subjects
medicine.medical_specialty ,Aging ,Heart disease ,heart failure ,Disease ,030204 cardiovascular system & hematology ,Cardiovascular ,Medical and Health Sciences ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,medicine ,Secondary Prevention ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Healthcare Disparities ,Intensive care medicine ,Stroke ,Heart Disease - Coronary Heart Disease ,Cause of death ,Framingham Risk Score ,business.industry ,Prevention ,cardiovascular health ,General Medicine ,Guideline ,Original Articles ,Health Status Disparities ,Health Services ,medicine.disease ,Atherosclerosis ,stroke ,Primary Prevention ,Heart Disease ,Good Health and Well Being ,Cardiovascular Diseases ,Heart failure ,Evidence-Based Practice ,Practice Guidelines as Topic ,Physical therapy ,Female ,Public Health ,business ,arrhythmias ,health disparity ,coronary artery disease - Abstract
Cardiovascular disease (CVD) remains the number one cause of death in women. It is estimated that 44 million women in the United States are either living with or at risk for heart disease. This article highlights the recent significant progress made in improving care, clinical decision-making, and policy implications for women with CVD. We provide our perspective supported by evidence-based advances in cardiovascular research and clinical care guidelines in seven areas: (1) primary CVD prevention and community heart care, (2) secondary prevention of CVD, (3) stroke, (4) heart failure and cardiomyopathies, (5) ischemia with nonobstructive coronary artery disease, (6) spontaneous coronary artery dissection, and (7) arrhythmias and device therapies. Advances in these fields have improved the lives of women living with and at risk for heart disease. With increase awareness, partnership with national organizations, sex-specific research, and changes in policy, the morbidity and mortality of CVD in women can be further reduced.
- Published
- 2018
46. Trastuzumab‐induced cardiac toxicity: Is serial assessment of left ventricular ejection fraction during treatment necessary?
- Author
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Tochi M. Okwuosa, Melody A. Cobleigh, Lolita Golemi, Nicole Prabhu, Louis Fogg, and Hena Patel
- Subjects
medicine.medical_specialty ,Ejection fraction ,business.industry ,Breast Neoplasms ,Stroke Volume ,Trastuzumab ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,Antineoplastic Agents, Immunological ,Oncology ,Internal medicine ,Cardiac toxicity ,Internal Medicine ,medicine ,Cardiology ,Humans ,Surgery ,business ,medicine.drug - Published
- 2019
47. 75-Year-Old Woman With Multiple Systemic Emboli
- Author
-
Hena Patel, Dinesh Kalra, and Katarzyna Mikrut
- Subjects
medicine.medical_specialty ,01 natural sciences ,Multimodal Imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Thromboembolism ,Medicine ,Echocardiography transthoracic ,Humans ,030212 general & internal medicine ,0101 mathematics ,Aged ,Endocarditis ,business.industry ,010102 general mathematics ,Anticoagulants ,Mitral Valve Insufficiency ,Heparin, Low-Molecular-Weight ,medicine.disease ,Embolism ,Echocardiography ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Published
- 2017
48. Spontaneous right-sided microcavitations in a healthy adult
- Author
-
Steven B. Feinstein, Stephen Boateng, Hena Patel, and Gurpreet Singh
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Pathology ,Radiological and Ultrasound Technology ,business.industry ,Peripheral edema ,Left atrium ,Case Report ,Right atrial ,medicine.anatomical_structure ,Anticoagulant therapy ,Left atrial ,Internal medicine ,Rare case ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,medicine.symptom ,business ,Normal heart - Abstract
Spontaneous echo contrast (SEC) is frequently observed in patients with structural and functional cardiovascular abnormalities. Literature describes cases of SEC either from agglutination of red blood cells and plasma proteins or from microcavitations. SEC secondary to the former is an independent predictor of future thromboembolic events and is most commonly observed in the left atrium or left atrial appendage. Thus, many authors reason that left atrial SEC is an indication for initiating anticoagulant therapy. We report a rare case of right atrial SEC that was incidentally found during echocardiographic evaluation of isolated peripheral edema in a healthy adult with a structurally normal heart. At present, there are no studies to offer guidance for management of right atrial SEC. This case emphasizes a necessary area of future research. Learning points Cardiovascular implications of SEC. Diagnostic evaluation and management of SEC.
- Published
- 2015
49. Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management
- Author
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Sarah Alexander, Sonal Chandra, Jeffrey Soble, Hena Patel, and Kim A. Williams
- Subjects
medicine.medical_specialty ,Mediterranean diet ,Disease ,030204 cardiovascular system & hematology ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Nutrient ,Environmental health ,Vegetables ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,chemistry.chemical_classification ,business.industry ,food and beverages ,Plant based ,chemistry ,Plant protein ,Cardiovascular Diseases ,Fruit ,Physical therapy ,Cardiology and Cardiovascular Medicine ,business ,Edible Grain ,Polyunsaturated fatty acid - Abstract
This review aims to summarize and discuss the role of plant-based nutrition as an adjunct to the management of cardiovascular disease (CVD). Discussion of nutrition and the benefits of a plant-based diet should be highlighted during healthcare provider visits as an essential part of the overall CVD prevention and management care plan. Evidence from prospective cohort studies indicates that a high consumption of predominantly plant-based foods, such as fruit and vegetables, nuts, and whole grains, is associated with a significantly lower risk of CVD. The protective effects of these foods are likely mediated through their multiple beneficial nutrients, including mono- and polyunsaturated fatty acids, omega-3 fatty acids, antioxidant vitamins, minerals, phytochemicals, fiber, and plant protein. In addition, minimizing intake of animal proteins has been shown to decrease the prevalence of CVD risk factors. Substantial evidence indicates that plant-based diets can play an important role in preventing and treating CVD and its risk factors. Such diets deserve more emphasis in dietary recommendations.
- Published
- 2017
50. Primary Prevention: The Best Way to Reduce Global CVD
- Author
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Hena Patel and Andrew Freeman
- Subjects
Risk analysis (engineering) ,Aside ,Primary prevention ,Business - Published
- 2019
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