262 results on '"Kirkpatrick JN"'
Search Results
2. Echocardiographic E, E', A and A' Wave Determinations: Exploring Measurement Biases between Non-Cardiologist Intensivists and Cardiologists.
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Stawicki, SP, primary, Doraiswamy, VA, additional, Kirkpatrick, JN, additional, Hayden, GE, additional, Gracias, VH, additional, and Dean, AJ, additional
- Published
- 2009
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3. Timing of neuroprognostication in postcardiac arrest therapeutic hypothermia*.
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Perman SM, Kirkpatrick JN, Reitsma AM, Gaieski DF, Lau B, Smith TM, Leary M, Fuchs BD, Levine JM, Abella BS, Becker LB, Merchant RM, Perman, Sarah M, Kirkpatrick, James N, Reitsma, Angelique M, Gaieski, David F, Lau, Bonnie, Smith, Thomas M, Leary, Marion, and Fuchs, Barry D
- Abstract
Objective: Early assessment of neurologic recovery is often challenging in survivors of cardiac arrest. Further, little is known about when to assess neurologic status in comatose, postarrest patients receiving therapeutic hypothermia. We sought to evaluate timing of prognostication in cardiac arrest survivors who received therapeutic hypothermia.Design: A retrospective chart review of consecutive postarrest patients receiving therapeutic hypothermia (protocol: 24-hr maintenance at target temperature followed by rewarming over 8 hrs). Data were abstracted from the medical chart, including documentation during the first 96 hrs post arrest of "poor" prognosis, diagnostic tests for neuroprognostication, consultations used for determination of prognosis, and outcome at discharge.Setting: Two academic urban emergency departments.Patients: A total of 55 consecutive patients who underwent therapeutic hypothermia were reviewed between September 2005 and April 2009.Intervention: None.Results: Of our cohort of comatose postarrest patients, 59% (29 of 49) were male, and the mean age was 56 ± 16 yrs. Chart documentation of "poor" or "grave" prognosis occurred "early": during induction, maintenance of cooling, rewarming, or within 15 hrs after normothermia in 57% (28 of 49) of cases. Of patients with early documentation of poor prognosis, 25% (seven of 28) had care withdrawn within 72 hrs post arrest, and 21% (six of 28) survived to discharge with favorable neurologic recovery. In the first 96 hrs post arrest: 88% (43 of 49) of patients received a head computed tomography, 90% (44 of 49) received electroencephalography, 2% (one of 49) received somatosensory evoked potential testing, and 71% (35 of 49) received neurology consultation.Conclusions: Documentation of "poor prognosis" occurred during therapeutic hypothermia in more than half of patients in our cohort. Premature documentation of poor prognosis may contribute to early decisions to withdraw care. Future guidelines should address when to best prognosticate in postarrest patients receiving therapeutic hypothermia. [ABSTRACT FROM AUTHOR]- Published
- 2012
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4. Deactivation of implantable cardioverter defibrillators in terminal illness and end of life care.
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Kirkpatrick JN, Gottlieb M, Sehgal P, Patel R, and Verdino RJ
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- 2012
5. Safety of pacemaker reuse: a meta-analysis with implications for underserved nations.
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Baman TS, Meier P, Romero J, Gakenheimer L, Kirkpatrick JN, Sovitch P, Oral H, and Eagle KA
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- 2011
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6. Pacemaker reuse: an initiative to alleviate the burden of symptomatic bradyarrhythmia in impoverished nations around the world.
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Baman TS, Kirkpatrick JN, Romero J, Gakenheimer L, Romero A, Lange DC, Nosowsky R, Fuller K, Sison EO, Tangco RV, Abelardo NS, Samson G, Sovitch P, Machado CE, Kemp SR, Morgenstern K, Goldman EB, Oral H, and Eagle KA
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- 2010
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7. Echocardiographic strain imaging and its use in the clinical setting.
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Cottrell C, Kirkpatrick JN, Cottrell, Caroline, and Kirkpatrick, James N
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The use of echocardiography has grown tremendously over the past several years. It is used routinely for diagnosis, prognosis and monitoring changes of cardiac function in coronary artery disease, heart failure, pulmonary hypertension, arrhythmias, pericardial disease and valvular disease, as well as congenital conditions. In recent years, the advancing technology used to evaluate the heart by ultrasound has allowed physicians to understand the mechanics of the heart muscle and the contribution of abnormalities in myocardial movement to heart disease. This review will discuss novel echocardiographic strain imaging techniques, placing them in the context of myocardial mechanics and describing current and future applications. [ABSTRACT FROM AUTHOR]
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- 2010
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8. The management of implantable cardiac devices at the end of life.
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Kirkpatrick JN and Knight BP
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- 2008
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9. Pain and symptom management. Medical house officers' attitudes toward vigorous analgesia, terminal sedation, and physician-assisted suicide.
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Kaldjian LC, Wu BJ, Kirkpatrick JN, Thomas-Geevarghese A, and Vaughan-Sarrazin M
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In 2000, the authors surveyed 236 medical house officers in three internal medicine residency programs in Connecticut to assess attitudes toward vigorous analgesia, terminal sedation, and physician-assisted suicide. The goal was to identify associations between these attitudes and training, demographic, and religious factors. The results of the study indicated that most medical house officers supported vigorous analgesia, the majority supported terminal sedation, but only a minority supported physician-assisted suicide. Some house officers' attitudes toward terminal sedation and assisted suicide may have been influenced by their religious commitments and the pressures of training. [ABSTRACT FROM AUTHOR]
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- 2004
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10. Postmortem analysis and retrieval of implantable pacemakers and defibrillators.
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Kirkpatrick JN, Burke MC, and Knight BP
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- 2006
11. Safety and efficacy of pacemaker reuse in underdeveloped nations a case series.
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Baman TS, Romero A, Kirkpatrick JN, Romero J, Lange DC, Sison EO, Tangco RV, Abelardo NS, Samson G, Grezlik R, Goldman EB, Oral H, and Eagle KA
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- 2009
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12. Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study
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Federico M. Asch, Tatsuya Miyoshi, Karima Addetia, Rodolfo Citro, Masao Daimon, Sameer Desale, Pedro Gutierrez Fajardo, Ravi R. Kasliwal, James N. Kirkpatrick, Mark J. Monaghan, Denisa Muraru, Kofo O. Ogunyankin, Seung Woo Park, Ricardo E. Ronderos, Anita Sadeghpour, Gregory M. Scalia, Masaaki Takeuchi, Wendy Tsang, Edwin S. Tucay, Ana Clara Tude Rodrigues, Amuthan Vivekanandan, Yun Zhang, Alexandra Blitz, Roberto M. Lang, Aldo D. Prado, Eduardo Filipini, Agatha Kwon, Samantha Hoschke-Edwards, Tania Regina Afonso, Babitha Thampinathan, Maala Sooriyakanthan, Tiangang Zhu, Zhilong Wang, Yingbin Wang, Mei Zhang, Yu Zhang, Lixue Yin, Shuang Li, R. Alagesan, S. Balasubramanian, R.V.A. Ananth, Manish Bansal, Luigi P. Badano, Chiara Palermo, Eduardo Bossone, Davide Di Vece, Michele Bellino, Tomoko Nakao, Takayuki Kawata, Megumi Hirokawa, Naoko Sawada, Yousuke Nabeshima, Hye Rim Yun, Ji-won Hwang, Dolapo Fasawe, Marcus Schreckenberg, Ricardo Ronderos, Gregory Scalia, V. Amuthan, Ravi Kasliwal, Pedro Gutierrez-Fajardo, James Kirkpatrick, Asch, F, Miyoshi, T, Addetia, K, Citro, R, Daimon, M, Desale, S, 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, Blitz, A, Lang, R, Prado, A, Filipini, E, Kwon, A, Hoschke-Edwards, S, Afonso, T, Thampinathan, B, Sooriyakanthan, M, Zhu, T, Wang, Z, Wang, Y, Zhang, M, Yin, L, Li, S, Alagesan, R, Balasubramanian, S, Ananth, R, Bansal, M, Badano, L, Palermo, C, Bossone, E, Di Vece, D, Bellino, M, Nakao, T, Kawata, T, Hirokawa, M, Sawada, N, Nabeshima, Y, Yun, H, Hwang, J, Fasawe, D, Schreckenberg, M, Amuthan, V, Gutierrez-Fajardo, P, Woo Park, S, Asch, Fm, Fajardo, Pg, Kasliwal, Rr, Kirkpatrick, Jn, Monaghan, Mj, Ogunyankin, Ko, Park, Sw, Ronderos, Re, Scalia, Gm, Rodrigues, Act, Lang, Rm, Prado, Ad, Afonso, Tr, Zhu, Tg, Wang, Zl, Wang, Yb, Yin, Lx, Ananth, Rva, Badano, Lp, Yun, Hr, and Hwang, Jw
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Adult ,Male ,medicine.medical_specialty ,Longitudinal strain ,Multiracial ,Heart Ventricles ,Normal values ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Normal value ,030218 nuclear medicine & medical imaging ,Age and gender ,03 medical and health sciences ,0302 clinical medicine ,Reference Values ,Interquartile range ,Internal medicine ,Ethnicity ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Societies, Medical ,Aged ,WASE ,Body surface area ,Ejection fraction ,business.industry ,Racial Groups ,Left ventricular size ,Stroke Volume ,Organ Size ,Middle Aged ,Left ventricle ,United States ,Cross-Sectional Studies ,Echocardiography ,International ,Cardiology ,Female ,Core laboratory ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: The World Alliance Societies of Echocardiography (WASE) Normal Values Study evaluates individuals from multiple countries and races with the aim of describing normative values that could be applied to the global community worldwide and to determine differences and similarities among people from different countries and races. The present report focuses specifically on two-dimensional (2D) left ventricular (LV) dimensions, volumes, and systolic function. Methods: The WASE Normal Values Study is a multicenter international, observational, prospective, cross-sectional study of healthy adult individuals. Participants recruited in each country were evenly distributed among six predetermined subgroups according to age and gender. Comprehensive 2D transthoracic echocardiograms were acquired and analyzed following strict protocols based on recent American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Analysis was performed at the WASE 2D core laboratory and included 2D LV dimensions, LV volumes, and LV ejection fraction (LVEF) by the biplane Simpson method and global longitudinal strain (GLS). Results: Two thousand eight subjects were enrolled in 15 countries. The median age was 45 years (interquartile range, 32–65 years), 42.8% were white, 41.8% were Asian, and 9.7% were black. LV dimensions and volumes were larger in male subjects, while LVEF and GLS were higher in female subjects. Global WASE normal ranges for LV dimensions were smaller than those in the guidelines, but the upper limits of normal for LV volumes and the lower limits of normal for LVEF were higher in the WASE study. Significant intercountry variation was identified for all LV parameters reflecting LV size (dimensions, mass, and volumes) even after indexing to body surface area, with LV end-diastolic and end-systolic volumes having the highest variation. The largest volumes were noted in Australia, while the smallest were measured in India for both genders. This finding suggests that in addition to gender and body surface area, specific country should be considered when evaluating LV volumes. Intercountry variation for LVEF and GLS was smaller but still statistically significant (P < .05 for all). Conclusions: LV dimensions and volumes are larger in men, while LVEF and GLS are higher in women. Current guideline-recommended normal ranges for LV volumes and LVEF should be adjusted. Intercountry variability is significant for LV volumes, and therefore nationality should be considered for defining ranges of normality.
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- 2019
13. 2024 ACC Expert Consensus Decision Pathway on Clinical Assessment, Management, and Trajectory of Patients Hospitalized With Heart Failure Focused Update: A Report of the American College of Cardiology Solution Set Oversight Committee.
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Hollenberg SM, Stevenson LW, Ahmad T, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Morris AA, Page RL 2nd, Siddiqi HK, Storrow AB, and Teerlink JR
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- Humans, United States, Societies, Medical, Disease Management, Heart Failure therapy, Cardiology standards, Consensus, Hospitalization
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- 2024
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14. Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature.
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Kirkpatrick JN, Panebianco N, Díaz-Gómez JL, Adhikari S, Bremer ML, Bronshteyn YS, Damewood S, Jankowski M, Johri A, Kaplan JRH, Kimura BJ, Kort S, Labovitz A, Lu JC, Ma IWY, Mayo PH, Mulvagh SL, Nikravan S, Cole SP, Picard MH, Sorrell VL, Stainback R, Thamman R, Tucay ES, Via G, and West FM
- Abstract
Point-of-care ultrasound (POCUS) involves the acquisition, interpretation, and immediate clinical integration of ultrasonographic imaging performed by a treating clinician. The current state of cardiac POCUS terminology is heterogeneous and ambiguous, in part because it evolved through siloed specialty practices. In particular, the medical literature and colloquial medical conversation contain a wide variety of terms that equate to cardiac POCUS. While diverse terminology aided in the development and dissemination of cardiac POCUS throughout multiple specialties, it also contributes to confusion and raises patient safety concerns. This statement is the product of a diverse and inclusive Writing Group from multiple specialties, including medical linguistics, that employed an iterative process to contextualize and standardize a nomenclature for cardiac POCUS. We sought to establish a deliberate vocabulary that is sufficiently unrelated to any specialty, ultrasound equipment, or clinical setting to enhance consistency throughout the academic literature and patient care settings. This statement (1) reviews the evolution of cardiac POCUS-related terms; (2) outlines specific recommendations, distinguishing between intrinsic and practical differences in terminology; (3) addresses the implications of these recommendations for current practice; and (4) discusses the implications for novel technologies and future research., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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15. JACC: Advances Expert Panel Perspective: Shared Decision-Making in Multidisciplinary Team-Based Cardiovascular Care.
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Perpetua EM, Palmer R, Le VT, Al-Khatib SM, Beavers CJ, Beckman JA, Bozkurt B, Coylewright M, Lloyd Doherty C, Guibone KA, Hawkey M, Keegan PA, Kirkpatrick JN, Laperle J, Lauck SB, Levine G, Lindman BR, Mack MJ, Price AL, Strong S, Wyman JF, Youmans QR, and Gulati M
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Shared decision-making (SDM) and multidisciplinary team-based care delivery are recommended across several cardiology clinical practice guidelines. However, evidence for benefit and guidance on implementation are limited. Informed consent, the use of patient decision aids, or the documentation of these elements for governmental or societal agencies may be conflated as SDM. SDM is a bidirectional exchange between experts: patients are the experts on their goals, values, and preferences, and clinicians provide their expertise on clinical factors. In this Expert Panel perspective, we review the current state of SDM in team-based cardiovascular care and propose best practice recommendations for multidisciplinary team implementation of SDM., Competing Interests: Dr Perpetua has been a consultant for Edwards Lifesciences and is a consultant for Abbott Vascular. Ms. Palmer is a consultant for Edwards Lifesciences. Dr Beckman is a consultant for Norvartis, Janssen, and JanOne. Dr Keegan is a consultant for Edwards Lifesciences and Abbott Vascular. Dr Guibone is a consultant for Medtronic and Abbott Vascular. Dr Lauck is a consultant for Edwards Lifesciences. Dr Le has received research grant funding from Janssen and is a consultant for 10.13039/100008272Novartis. Dr Lindman is supported by R01AG073633 from the 10.13039/100000002National Institutes of Health and has been a consultant for and received investigator-initiated research grants from 10.13039/100006520Edwards Lifesciences. Dr Wyman has been a consultant for Edwards Lifesciences and Boston Scientific. Dr Gulati has been a consultant for Esperion, Boehringer Ingelheim, and Medtronic. There was no funding support for this expert panel. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
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- 2024
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16. Ethical and Equity Guidance for Transplant Programs Considering Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) for Procurement of Hearts.
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Dudzinski DM, Pal JD, and Kirkpatrick JN
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- Humans, Organ Preservation ethics, United States, Tissue Donors ethics, Informed Consent ethics, Death, Cadaver, Perfusion, Heart Transplantation ethics, Tissue and Organ Procurement ethics
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Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical "authorization," for cadaveric organ donation using TA-NRP.
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- 2024
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17. Limitations of apical sparing pattern in cardiac amyloidosis: a multicentre echocardiographic study.
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Cotella J, Randazzo M, Maurer MS, Helmke S, Scherrer-Crosbie M, Soltani M, Goyal A, Zareba K, Cheng R, Kirkpatrick JN, Yogeswaran V, Kitano T, Takeuchi M, Fernandes F, Hotta VT, Campos Vieira ML, Elissamburu P, Ronderos R, Prado A, Koutroumpakis E, Deswal A, Pursnani A, Sarswat N, Addetia K, Mor-Avi V, Asch FM, Slivnick JA, and Lang RM
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- Humans, Female, Male, Middle Aged, Aged, Cardiomyopathies diagnostic imaging, Case-Control Studies, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left physiopathology, Retrospective Studies, ROC Curve, Amyloidosis diagnostic imaging, Echocardiography methods
- Abstract
Aims: Although impaired left ventricular (LV) global longitudinal strain (GLS) with apical sparing is a feature of cardiac amyloidosis (CA), its diagnostic accuracy has varied across studies. We aimed to determine the ability of apical sparing ratio (ASR) and most common echocardiographic parameters to differentiate patients with confirmed CA from those with clinical and/or echocardiographic suspicion of CA but with this diagnosis ruled out., Methods and Results: We identified 544 patients with confirmed CA and 200 controls (CTRLs) as defined above (CTRL patients). Measurements from transthoracic echocardiograms were performed using artificial intelligence software (Us2.AI, Singapore) and audited by an experienced echocardiographer. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance and optimal cut-offs for the differentiation of CA patients from CTRL patients. Additionally, a group of 174 healthy subjects (healthy CTRL) was included to provide insight on how patients and healthy CTRLs differed echocardiographically. LV GLS was more impaired (-13.9 ± 4.6% vs. -15.9 ± 2.7%, P < 0.0005), and ASR was higher (2.4 ± 1.2 vs. 1.7 ± 0.9, P < 0.0005) in the CA group vs. CTRL patients. Relative wall thickness and ASR were the most accurate parameters for differentiating CA from CTRL patients [area under the curve (AUC): 0.77 and 0.74, respectively]. However, even with the optimal cut-off of 1.67, ASR was only 72% sensitive and 66% specific for CA, indicating the presence of apical sparing in 32% of CTRL patients and even in 6% healthy subjects., Conclusion: Apical sparing did not prove to be a CA-specific biomarker for accurate identification of CA, when compared with clinically similar CTRLs with no CA., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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18. Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus.
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Oto B, Baeten R, Chen L, Dalal P, Dancel R, Fox S, Lange Iv CW, Baston C, Bornemann P, Dugar S, Goldsmith A, Herbst MK, Kirkpatrick JN, Koratala A, Lanspa MJ, Lobo V, Nomura JT, Pustavoitau A, Senussi MH, Sorrell VL, West FM, and Sarwal A
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Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs., Competing Interests: AG has received grants from NIH and consulting fees from Butterfly Network and Ultrasight. AK has received research funding from KidneyCure and the American Society of Nephrology. JK is the chair of the American Society of Echocardiography’s Scientific Statement Writing Group on Nomenclature of cardiac POCUS, and a member of the Critical Care Echocardiography Council Leadership Group., (Copyright (c) 2024 Brandon Oto, PA-C, FCCM, Robert Baeten, PA-C, FCCP, Leon Chen, DNP, AGACNP-BC, FCCP, FAANP, FCCM, Puja Dalal, MD, FAAFP, Ria Dancel, MD, FACP, SFHM, FAAP, Steven Fox, MD, Carl William Lange, IV, MSBS, EM-CAQ, PA-C, Cameron Baston, MD, MSCE, FACP, Paul Bornemann, MD, RMSK, RPVI, Siddharth Dugar, MD, FCCM, FASE, FCCP, Andrew Goldsmith, MD, MBA, Meghan Kelly Herbst, MD, FACEP, James N. Kirkpatrick, MD, FASE, FACC, Abhilash Koratala, MD, FASN, Michael J. Lanspa, MD, Viveta Lobo, MD, FACEP, Jason T Nomura, MD, FACEP, FAAEM, FACP, FAHA, Aliaksei Pustavoitau, MD, MHS, FCCM, Mourad H Senussi, MD, MS, Vincent L. Sorrell, MD, FACP (honorary), FACC, FASE, FSCCT, FSCMR, Frances Mae West, MD, MS, FACP, Aarti Sarwal, MD, FNCS, FAAN, FCCM, FASN, RPNI.)
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- 2024
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19. TAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series.
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Damluji AA, Bernacki G, Afilalo J, Lyubarova R, Orkaby AR, Kwak MJ, Hummel S, Kirkpatrick JN, Maurer MS, Wenger N, Rich MW, Kim DH, Wang RY, Forman DE, and Krishnaswami A
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Calcific aortic stenosis can be considered a model for geriatric cardiovascular conditions due to a confluence of factors. The remarkable technological development of transcatheter aortic valve replacement was studied initially on older adult populations with prohibitive or high-risk for surgical valve replacement. Through these trials, the cardiovascular community has recognized that stratification of these chronologically older adults can be improved incrementally by invoking the concept of frailty and other geriatric risks. Given the complexity of the aging process, stratification by chronological age should only be the initial step but is no longer sufficient to optimally quantify cardiovascular and noncardiovascular risk. In this review, we employ a geriatric cardiology lens to focus on the diagnosis and the comprehensive management of aortic stenosis in older adults to enhance shared decision-making with patients and their families and optimize patient-centered outcomes. Finally, we highlight knowledge gaps that are critical for future areas of study.
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- 2024
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20. Reply: Ethical and Moral Complexities of Left Ventricular Assist Device Deactivation: Embracing the Uncertainty.
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Zaidi D, Kirkpatrick JN, Fedson SE, and Hull SC
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- Humans, Uncertainty, Morals, Heart-Assist Devices, Heart Failure surgery
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- 2024
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21. Proposal and Rationale for a Cardioethics Curriculum.
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Hull SC, Mullen JB, and Kirkpatrick JN
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The modern practice of cardiovascular medicine involves many ethical controversies in the care of our complex patients. Accordingly, we propose a framework for a practical, clinically based "cardioethics" curriculum that might be incorporated into fellowship training to prepare cardiologists to cope with increasingly complex ethical dilemmas. This work can also be adopted into continuing medical education for cardiologists and other cardiovascular practitioners given the critical importance of collaborative care in cardiology. We discuss heart transplant allocation, futility concerns, withdrawing care, advance care planning, conflicts of interests, and distributive justice. Sound ethical decision-making in cardiology requires a combination of extensive technical knowledge, nuanced appreciation of individual patient goals and values, and thoughtful application of ethical principles and reasoning. Cardiologists have an exceptionally broad toolkit of medications and interventions to address high-stakes disease states. We should maintain a similarly broad ethical toolkit to provide the best care for our patients., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
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- 2024
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22. Cardiovascular Disease in the Older Adult: Where Are We 4 Decades Later?
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Forouzandeh F, Alexander K, Forman D, Kirkpatrick JN, Rich MW, Zieman S, and Wenger NK
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The 1986 Bethesda Conference on Cardiovascular Disease (CVD) in the Elderly, co-chaired by Drs. Nanette Wenger, Frank Marcus, and Robert O'Rourke, delineated the anticipated social, political, ethical, economic and technological impact of an aging population on the incidence, prevalence, and management of CVD in the US and worldwide. In the ensuing 4 decades, older patients have come to comprise an increasingly large proportion of the CVD population, and there has been an explosion of research in all aspects of CVD affecting older adults. Correspondingly, Geriatric Cardiology is now an established field within cardiovascular medicine. In this communication, we provide a focused update on intersections between CVD and geriatrics from basic science to clinical practice, a review of major advances in diagnosis and treatment of older adults with CVD, and a preview of future research directions in the still evolving field of geriatric cardiology.
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- 2024
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23. End-of-Life Planning in Patients with Mechanical Circulatory Support.
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Truong KP and Kirkpatrick JN
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- Humans, Death, Heart Failure therapy, Heart-Assist Devices, Heart Transplantation
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There are a growing number of patients with mechanical circulatory support (MCS) in the setting of bridge to transplant and destination therapy and temporary support. Preparedness planning is an important aspect of care that involves device-specific Goals of Care and Advance Care Planning and should ideally be used in MCS candidates before initiation of therapy and revisited periodically. The withdrawal of both temporary and durable MCS can be complex and controversial., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2024
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24. Deep learning assisted measurement of echocardiographic left heart parameters: improvement in interobserver variability and workflow efficiency.
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Mor-Avi V, Blitz A, Schreckenberg M, Addetia K, Kebed K, Scalia G, Badano LP, Kirkpatrick JN, Gutierrez-Fajardo P, Tude Rodrigues AC, Sadeghpour A, Tucay ES, Prado AD, Tsang W, Ogunyankin KO, Rossmanith A, Schummers G, Laczik D, Asch FM, and Lang RM
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- Humans, Heart Ventricles diagnostic imaging, Observer Variation, Workflow, Reproducibility of Results, Predictive Value of Tests, Echocardiography, Deep Learning, Echocardiography, Three-Dimensional methods
- Abstract
Machine learning techniques designed to recognize views and perform measurements are increasingly used to address the need for automation of the interpretation of echocardiographic images. The current study was designed to determine whether a recently developed and validated deep learning (DL) algorithm for automated measurements of echocardiographic parameters of left heart chamber size and function can improve the reproducibility and shorten the analysis time, compared to the conventional methodology. The DL algorithm trained to identify standard views and provide automated measurements of 20 standard parameters, was applied to images obtained in 12 randomly selected echocardiographic studies. The resultant measurements were reviewed and revised as necessary by 10 independent expert readers. The same readers also performed conventional manual measurements, which were averaged and used as the reference standard for the DL-assisted approach with and without the manual revisions. Inter-reader variability was quantified using coefficients of variation, which together with analysis times, were compared between the conventional reads and the DL-assisted approach. The fully automated DL measurements showed good agreement with the reference technique: Bland-Altman biases 0-14% of the measured values. Manual revisions resulted in only minor improvement in accuracy: biases 0-11%. This DL-assisted approach resulted in a 43% decrease in analysis time and less inter-reader variability than the conventional methodology: 2-3 times smaller coefficients of variation. In conclusion, DL-assisted approach to analysis of echocardiographic images can provide accurate left heart measurements with the added benefits of improved reproducibility and time savings, compared to conventional methodology., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)
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- 2023
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25. The American Society of Echocardiography Foundation (ASEF): Foundation for the Future of Cardiovascular Ultrasound.
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Eidem BW and Kirkpatrick JN
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- Humans, United States, Ultrasonography, Echocardiography, Cardiovascular System
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- 2023
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26. Relationship between BMI and prognosis of chronic heart failure outpatients in Vietnam: a single-center study.
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Nguyen HTT, Ha TTT, Tran HB, Nguyen DV, Pham HM, Tran PM, Pham TM, Allison TG, Reid CM, and Kirkpatrick JN
- Abstract
Background: Insufficient data exists regarding the relationship between body mass index (BMI) and the prognosis of chronic heart failure (CHF) specifically within low- and middle-income Asian countries. The objective of this study was to evaluate the impact of BMI on adverse outcomes of ambulatory patients with CHF in Vietnam., Methods: Between 2018 and 2020, we prospectively enrolled consecutive outpatients with clinically stable CHF in an observational cohort, single-center study. The participants were stratified according to Asian-specific BMI thresholds. The relationships between BMI and adverse outcomes (all-cause death and all-cause hospitalization) were analyzed by Kaplan-Meier survival curves and Cox proportional-hazards model., Results: Among 320 participants (age 63.5 ± 13.3 years, 57.9% male), the median BMI was 21.4 kg/m
2 (IQR 19.5-23.6), and 10.9% were underweight (BMI <18.50 kg/m2 ). Over a median follow-up time of 32 months, the cumulative incidence of all-cause mortality and hospitalization were 5.6% and 19.1%, respectively. After multivariable adjustment, underweight patients had a significantly higher risk of all-cause mortality than patients with normal BMI (adjusted hazard ratios = 3.03 [95% CI: 1.07-8.55]). Lower BMI remained significantly associated with a worse prognosis when analyzed as a continuous variable (adjusted hazard ratios = 1.27 [95% CI: 1.03-1.55] per 1 kg/m2 decrease for all-cause mortality). However, BMI was not found to be significantly associated with the risk of all-cause hospitalization ( p > 0.05)., Conclusion: In ambulatory patients with CHF in Vietnam, lower BMI, especially underweight status (BMI < 18.5 kg/m2 ), was associated with a higher risk of all-cause mortality. These findings suggest that BMI should be considered for use in risk classification, and underweight patients should be managed by a team consisting of cardiologists, nutritionists, and geriatricians., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nguyen, Ha, Tran, Nguyen, Pham, Tran, Pham, Allison, Reid and Kirkpatrick.)- Published
- 2023
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27. Deactivation of Left Ventricular Assist Devices at the End of Life: Narrative Review and Ethical Framework.
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Zaidi D, Kirkpatrick JN, Fedson SE, and Hull SC
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- Humans, Death, Heart Failure therapy, Heart-Assist Devices, Hospice Care, Advance Care Planning
- Abstract
Left ventricular assist devices (LVADs) have become an increasingly common advanced therapy in patients with severe symptomatic heart failure. Their unique nature in prolonging life through incorporation into the circulatory system raises ethical questions regarding patient identity and values, device ontology, and treatment categorization; approaching requests for LVAD deactivation requires consideration of these factors, among others. To that end, clinicians would benefit from a deeper understanding of: 1) the history and nature of LVADs; 2) the wider context of device deactivation and associated ethical considerations; and 3) an introductory framework incorporating best practices in requests for LVAD deactivation (specifically in controversial situations without obvious medical or device-related complications). In such decisions, heart failure teams can safeguard patient preferences without compromising ethical practice through more explicit advance care planning before LVAD implantation, early integration of hospice and palliative medicine specialists (maintained throughout the disease process), and further research interrogating behaviors and attitudes related to LVAD deactivation., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2023
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28. American Society of Echocardiography COVID-19 Statement Update: Lessons Learned and Preparation for Future Pandemics.
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Kirkpatrick JN, Swaminathan M, Adedipe A, Garcia-Sayan E, Hung J, Kelly N, Kort S, Nagueh S, Poh KK, Sarwal A, Strachan GM, Topilsky Y, West C, and Wiener DH
- Subjects
- Humans, United States epidemiology, Pandemics, Echocardiography, Societies, Medical, COVID-19 epidemiology
- Abstract
The COVID-19 pandemic has evolved since the publication of the initial American Society of Echocardiography (ASE) statements providing guidance to echocardiography laboratories. In light of new developments, the ASE convened a diverse, expert writing group to address the current state of the COVID-19 pandemic and to apply lessons learned to echocardiography laboratory operations in future pandemics. This statement addresses important areas specifically impacted by the current and future pandemics: (1) indications for echocardiography, (2) application of echocardiographic services in a pandemic, (3) infection/transmission mitigation strategies, (4) role of cardiac point-of-care ultrasound/critical care echocardiography, and (5) training in echocardiography., (Copyright © 2023. Published by Elsevier Inc.)
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- 2023
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29. Cardiac Interventions in the Absence of Assent: An Ethical Dilemma.
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Kersey CB, Ashinne B, Keenan J, and Kirkpatrick JN
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- Female, Humans, Middle Aged, Decision Making, Aortic Valve surgery, Heart Valve Prosthesis
- Abstract
A 63-year-old woman with schizophrenia presented with prosthetic mitral valve endocarditis complicated by complete heart block and declined surgical intervention. The patient was deemed to not have decisional capacity after a formal evaluation by the psychiatry service, and a surrogate decision-maker used the ethical principles of substituted judgment and best interest standards for surgical consent on behalf of the patient. The patient provided passive assent (did not resist transport to the operating room). The patient underwent successful redo mitral and aortic valve replacements and recovered well postoperatively. In conclusion, it is important for cardiovascular clinicians to be familiar with the ethical elements of surrogate decision-making, including patient autonomy and its limits, determination of decision-making capacity, and the standard of surrogate decision-making., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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30. Expanding the Paradigm for Cardiovascular Palliative Care.
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Godfrey S, Kirkpatrick JN, Kramer DB, and Sulistio MS
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- Humans, Adult, Palliative Care, Quality of Life, Heart Defects, Congenital, Heart Failure, Peripheral Arterial Disease
- Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite medical advances, patients with CVD experience high morbidity and mortality rates, affecting their quality of life and death. Among CVD conditions, palliative care has been studied mostly in patients with heart failure, where palliative care interventions have been associated with improvements in patient-centered outcomes, including quality of life, end-of-life care, and health care use. Although palliative care is now incorporated into the American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines for heart failure, the role of palliative care for non-heart failure CVD remains uncertain. Across all causes of CVD, palliative care can play an important role in all domains of CVD care from initial diagnosis to terminal care. In addition to general cardiovascular palliative care practices applicable to all areas, disease-specific palliative care needs may warrant individualized palliative care models. In this review, we discuss the role of cardiovascular palliative care for ischemic heart disease, valvular disease, arrhythmias, peripheral artery disease, and adult congenital heart disease. Although there are multiple barriers to cardiovascular palliative care, we recommend a framework for studying and developing cardiovascular palliative care models to improve patient-centered goal-concordant care for this underserved patient population., Competing Interests: Disclosures None.
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- 2023
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31. Staying Alive: Patients Who Lived Through Disco Era Benefit From Bystander CPR.
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Kirkpatrick JN, Kersey CB, and Truong KP
- Abstract
Competing Interests: Dr Kirkpatrick receives salary support from NHLBI and NIDDK studies (National Institutes of Health). The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- 2023
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32. What the 'greater good' excludes: Patients left behind by pre-operative COVID-19 screening in an Ethiopian town.
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Campelia GD, Suga HK, Kempen JH, Kirkpatrick JN, and Jecker NS
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- Humans, SARS-CoV-2, Policy, Pandemics prevention & control, Ethiopia epidemiology, COVID-19 diagnosis
- Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, bioethical analyses often emphasized population health and societal benefit. Hospital policies frequently focused on reducing risk of transmitting SARS-CoV-2 by restricting visitors; requiring protective equipment; and screening staff, patients and visitors. While restrictions can be burdensome, they are often justified as essential measures to protect the whole population against a virus with high rates of transmission, morbidity and mortality. Yet communities are not monolithic, and the impacts of these restrictions affect different groups differently. An ophthalmological unit outreach program in Ethiopia serves to illustrate. Pre-operative screening policies were designed to protect as many patients as possible but had adverse impacts on underserved communities. As this case study demonstrates, creating hospital policies that truly serve the good of the society may require a more holistic review of impacts on inequitably positioned communities., (© 2022 John Wiley & Sons Ltd.)
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- 2023
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33. A Vision for the Future of Quality in Echocardiographic Reporting: The American Society of Echocardiography ImageGuideEcho Registry, Current and Future States.
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Nagueh SF, Klein AL, Scherrer-Crosbie M, Fine NM, Kirkpatrick JN, Forsha DE, Nicoara A, Mackensen GB, Tilkemeier PL, Doukky R, Cheema B, Adusumalli S, Hill JC, Tanguturi VK, Ouyang D, Bdoyan SB, and Strom JB
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- Humans, United States, Registries, Echocardiography
- Published
- 2023
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34. Normal Values of Three-Dimensional Right Ventricular Size and Function Measurements: Results of the World Alliance Societies of Echocardiography Study.
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Addetia K, Miyoshi T, Amuthan V, Citro R, Daimon M, Gutierrez Fajardo P, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Zhang Y, Singulane CC, Hitschrich N, Blankenhagen M, Degel M, Schreckenberg M, Mor-Avi V, Asch FM, and Lang RM
- Subjects
- Male, Humans, Female, Aged, Reference Values, Reproducibility of Results, Stroke Volume, Echocardiography, Ventricular Function, Right, Heart Ventricles diagnostic imaging, Echocardiography, Three-Dimensional methods
- Abstract
Background: Normal values for three-dimensional (3D) right ventricular (RV) size and function are not well established, as they originate from small studies that involved predominantly white North American and European populations, did not use RV-focused views, and relied on older 3D RV analysis software. The World Alliance Societies of Echocardiography study was designed to generate reference ranges for normal subjects around the world. The aim of this study was to assess the worldwide capability of 3D imaging of the right ventricle and report size and function measurements, including their dependency on age, sex, and ethnicity., Methods: Healthy subjects free of cardiac, pulmonary, and renal disease were prospectively enrolled at 19 centers in 15 countries, representing six continents. Three-dimensional wide-angle RV data sets were obtained and analyzed using dedicated RV software (TomTec) to measure end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume, and ejection fraction (EF). Results were categorized by sex, age (18-40, 41-65, and >65 years) and ethnicity., Results: Of the 2,007 subjects with attempted 3D RV acquisitions, 1,051 had adequate image quality for confident measurements. Upper and lower limits for body surface area-indexed EDV, ESV, and EF were 48 and 95 mL/m
2 , 19 and 43 mL/m2 , and 44% and 58%, respectively, for men and 42 and 81 mL/m2 , 16 and 36 mL/m2 , and 46% and 61%, respectively, for women. Men had significantly larger EDVs, ESVs, and stroke volumes (even after body surface area indexing) and lower EFs than women (P < .05). EDV and ESV did not show any meaningful differences among age groups. Three-dimensional RV volumes were smallest in Asians., Conclusions: Reliability of 3D RV acquisition is low worldwide, underscoring the importance of future improvements in imaging techniques. Sex and race must be taken into consideration in the assessment of both RV volumes and EF., (Copyright © 2023 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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35. A Geriatric Approach to Percutaneous Coronary Interventions in Older Adults, Part II: A JACC: Advances Expert Panel.
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Nanna MG, Sutton NR, Kochar A, Rymer JA, Lowenstern AM, Gackenbach G, Hummel SL, Goyal P, Rich MW, Kirkpatrick JN, Krishnaswami A, Alexander KP, Forman DE, Bortnick AE, Batchelor W, and Damluji AA
- Abstract
We review a comprehensive risk assessment approach for percutaneous coronary interventions in older adults and highlight the relevance of geriatric syndromes within that broader perspective to optimize patient-centered outcomes in interventional cardiology practice. Reflecting the influence of geriatric principles in older adults undergoing percutaneous coronary interventions, we propose a "geriatric" heart team to incorporate the expertise of geriatric specialists in addition to the traditional heart team members, facilitate uptake of the geriatric risk assessment into the preprocedural risk assessment, and address ways to mitigate these geriatric risks. We also address goals of care in older adults, highlighting common priorities that can impact shared decision making among older patients, as well as frequently encountered pharmacotherapeutic considerations in the older adult population. Finally, we clarify gaps in current knowledge and describe crucial areas for future investigation.
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- 2023
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36. Age-, Sex-, and Race-Based Normal Values for Left Ventricular Circumferential Strain from the World Alliance Societies of Echocardiography Study.
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Singulane CC, Miyoshi T, Mor-Avi V, Cotella JI, Schreckenberg M, Blankenhagen M, Hitschrich N, Addetia K, Amuthan V, Citro R, Daimon M, Gutiérrez-Fajardo P, Kasliwal R, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Tude Rodrigues AC, Ronderos R, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Zhang Y, Asch FM, and Lang RM
- Subjects
- Adult, Male, Humans, Female, Middle Aged, Reference Values, Echocardiography methods, Heart Ventricles diagnostic imaging, Healthy Volunteers, Ventricular Function, Left, Ventricular Dysfunction, Left
- Abstract
Background: Left ventricular (LV) circumferential strain has received less attention than longitudinal deformation, which has recently become part of routine clinical practice. Among other reasons, this is because of the lack of established normal values. Accordingly, the aim of this study was to establish normative values for LV circumferential strain and determine sex-, age-, and race-related differences in a large cohort of healthy adults., Methods: Complete two-dimensional transthoracic echocardiograms were obtained in 1,572 healthy subjects (51% men), enrolled in the World Alliance Societies of Echocardiography Normal Values Study. Subjects were divided into three age groups (<35, 35-55, and >55 years) and stratified by sex and by race. Vendor-independent semiautomated speckle-tracking software was used to determine LV regional circumferential strain and global circumferential strain (GCS) values. Limits of normal for each measurement were defined as 95% of the corresponding sex and age group falling between the 2.5th and 97.5th percentiles. Intergroup differences were analyzed using unpaired t tests., Results: Circumferential strain showed a gradient, with lower magnitude at the mitral valve level, increasing progressively toward the apex. Compared with men, women had statistically higher magnitudes of regional and global strain. Older age was associated with a stepwise increase in GCS despite an unaffected ejection fraction, a decrease in LV volume, and relatively stable global longitudinal strain in men, with a small gradual decrease in women. Asian subjects demonstrated significantly higher GCS magnitudes than whites of both sexes and blacks among women only. In contrast, no significant differences in GCS were found between white and black subjects of either sex. Importantly, despite statistical significance of these differences across sex, age, and race, circumferential strain values were similar in all groups, with variations of the order of magnitude of 1% to 2%. Notably, no differences in GCS were found among brands of imaging equipment., Conclusion: This study established normal values of LV regional circumferential strain and GCS and identified sex-, age-, and race-related differences when present., (Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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37. Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel.
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Nanna MG, Sutton NR, Kochar A, Rymer JA, Lowenstern AM, Gackenbach G, Hummel SL, Goyal P, Rich MW, Kirkpatrick JN, Krishnaswami A, Alexander KP, Forman DE, Bortnick AE, Batchelor W, and Damluji AA
- Abstract
As the population ages, older adults represent an increasing proportion of patients referred to the cardiac catheterization laboratory. Older adults are the highest-risk group for morbidity and mortality, particularly after complex, high-risk percutaneous coronary interventions. Structured risk assessment plays a key role in differentiating patients who are likely to derive net benefit vs those who have disproportionate risks for harm. Conventional risk assessment tools from national cardiovascular societies typically rely on 3 pillars: 1) cardiovascular risk; 2) physiologic and hemodynamic risk; and 3) anatomic and procedural risks. We propose adding a fourth pillar: geriatric syndromes, as geriatric domains can supersede all other aspects of risk.
- Published
- 2023
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38. Limited English Proficiency in Older Adults Referred to the Cardiovascular Team.
- Author
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Medrano FJ, Fernandez AJ, Sudore RL, Kirkpatrick JN, Benda NC, Creber RM, Goyal P, Beavers C, Maurer MS, Rich MW, Alexander KP, and Krishnaswami A
- Subjects
- Humans, Aged, Language, Communication Barriers, Limited English Proficiency
- Abstract
Limited English proficiency (LEP) is defined as individuals in whom English is not the primary language and who have limited ability to read, speak, write, or understand the English language. Cardiovascular (CV) team members routinely encounter language barriers in their practice. These barriers have a significant impact on the quality of CV care that patients with LEP receive. Despite evidence demonstrating the negative association between language barriers and health disparities, the impact on CV care is insufficiently known. In addition, older adults with CV disease and LEP are facing increasing risk of adverse events when complex medical information is not optimally delivered. Overcoming language barriers in CV care will need a thoughtful approach. Although well recognized, the initial step will be to continue to highlight the importance of language needs identification and appropriate use of professional interpreter services. In parallel, a health system-level approach is essential that describes initiatives and key policies to ensure a high-level quality of care for a growing LEP population. This review aims to present the topic of LEP during the CV care of older adults, for continued awareness along with practical considerations for clinical use and directions for future research., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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39. The Quality and Safety of Sedation and Monitoring in Adults Undergoing Nonoperative Transesophageal Echocardiography.
- Author
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Kersey CB, Lele AV, Johnson MN, Pattock AM, Liu L, Huang GS, Kirkpatrick JN, Mazimba S, Jobarteh S, and Kwon Y
- Subjects
- Adult, Humans, Echocardiography, Heart, Hemodynamics, Echocardiography, Transesophageal methods, Hypotension epidemiology
- Abstract
Sedation is an essential component of the transesophageal echocardiography (TEE) procedure for patient comfort. The use and the clinical implications of cardiologist-supervised (CARD-Sed) versus anesthesiologist-supervised sedation (ANES-Sed) are unknown. We reviewed nonoperative TEE records from a single academic center over a 5-year period and identified CARD-Sed and ANES-Sed cases. We evaluated the impact of patient co-morbidities, cardiac abnormalities on transthoracic echocardiogram, and the indication for TEE on sedation practice. We analyzed the use of CARD-Sed versus ANES-Sed in light of institutional guidelines; the consistency in the documentation of preprocedural risk stratification; and the incidence of cardiopulmonary events, including hypotension, hypoxia, and hypercarbia. A total of 914 patients underwent TEE, with 475 patients (52%) receiving CARD-Sed and 439 patients (48%) receiving ANES-Sed. The presence of obstructive sleep apnea (p = 0.008), a body mass index of >45 kg/m
2 (p <0.001), an ejection fraction of <30% (p <0.001), and pulmonary artery systolic pressure of more than 40 mm Hg (p = 0.015) were all associated with the use of ANES-Sed. Of the 178 patients (19.5%) with at least 1 caution to nonanesthesiologist-supervised sedation by the institutional screening guideline, 65 patients (36.5%) underwent CARD-Sed. In the ANES-Sed group, where intraprocedural vital signs and medications were documented in all cases, hypotension (n = 91, 20.7%), vasoactive medication use (n = 121, 27.6%), hypoxia (n = 35, 8.0%), and hypercarbia (n = 50, 11.4%) were noted. This single-center study revealed that 48% of the nonoperative TEE used ANES-Sed over 5 years. Sedation-related hemodynamic changes and respiratory events were not infrequently encountered during ANES-Sed., (Copyright © 2023 Elsevier Inc. All rights reserved.)- Published
- 2023
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40. Normal Values of Left Ventricular Mass by Two-Dimensional and Three-Dimensional Echocardiography: Results from the World Alliance Societies of Echocardiography Normal Values Study.
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Lee L, Cotella JI, Miyoshi T, Addetia K, Schreckenberg M, Hitschrich N, Blankenhagen M, Amuthan V, Citro R, Daimon M, Gutiérrez-Fajardo P, Kasliwal R, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Tude Rodrigues AC, Ronderos R, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Zhang M, Mor-Avi V, Asch FM, and Lang RM
- Subjects
- Adult, Male, Middle Aged, Humans, Female, Aged, Adolescent, Young Adult, Reference Values, Hypertrophy, Left Ventricular, Echocardiography, Ventricular Function, Left, Heart Ventricles diagnostic imaging, Echocardiography, Three-Dimensional methods
- Abstract
Background: Although increased left ventricular (LV) mass is associated with adverse outcomes, measured values vary widely depending on the specific technique used. Moreover, the impact of sex, age, and race on LV mass remains controversial, further limiting the clinical use of this parameter. Accordingly, the authors studied LV mass using a variety of two-dimensional and three-dimensional echocardiographic techniques in a large population of normal subjects encompassing a wide range of ages., Methods: Transthoracic echocardiograms obtained from 1,854 healthy adult subjects (52% men) enrolled in the World Alliance Societies of Echocardiography (WASE) Normal Values Study, were divided into three age groups (young, 18-35 years; middle aged, 36-55 years; and old, >55 years). LV mass was obtained using five conventional techniques, including linear and two-dimensional methods, as well as direct three-dimensional measurement. All LV mass values were indexed to body surface area, and differences according to sex, age, and race were analyzed for each technique., Results: LV mass values differed significantly among the five techniques. Three-dimensional measurements were considerably smaller than those obtained using the other techniques and were closer to magnetic resonance imaging normal values reported in the literature. For all techniques, LV mass in men was significantly larger than in women, with and without body surface area indexing. These technique- and sex-related differences were larger than measurement variability. In women, age differences in LV mass were more pronounced and depicted significantly larger values in older age groups for all techniques, except three-dimensional echocardiography, which showed essentially no differences. LV mass was overall larger in black subjects than in white or Asian subjects., Conclusions: Significant differences in LV mass values exist across echocardiographic techniques, which are therefore not interchangeable. Sex-, race-, and age-related differences underscore the need for separate population specific normal values., (Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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41. Diagnostic accuracy of two-dimensional and three-dimensional transesophageal echocardiography in detecting pannus and thrombus in left mechanical valve obstruction.
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Pham TTT, Kirkpatrick JN, Duong HD, Pham HM, Vu TT, Giap NTM, Trinh HV, Nguyen YTH, Hoang MTN, and Nguyen HTT
- Abstract
The aim of this study was to determine the accuracy of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the detection of pannus and thrombus in left mechanical valve obstruction (LMVO) compared with surgical and histopathology findings., Materials and Methods: Patients with suspected LMVO on transthoracic echocardiography were enrolled consecutively. All patients underwent two-dimensional and three-dimensional TEE, and open-heart surgery to replace obstructed valves. Macroscopic and microscopic analysis of the excised masses was used as the gold standard for the diagnosis of thrombus and/or pannus., Results: Forty-eight patients [34 women (70.8%), age 49±13 years, New York Heart Association II: 68.8%, New York Heart Association III: 31.2%] were enrolled. In the diagnostic of thrombus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 89.2, 72.7, 85.4, 91.7, and 66.7%, respectively, compared with those of two-dimensional TEE (42.2, 66.7, 43.8, 95, and 7.1%, respectively). In the diagnosis of pannus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 53.3, 100, 85.4, 100, and 82.5%, respectively; compared with those of two-dimensional TEE (7.4, 90.5, 43.8, 50, and 43.2%, respectively). Receiver operating characteristic curves depict that the area under the curves of three-dimensional TEE was higher than the area under the curves of two-dimensional TEE in both diagnoses of thrombus and pannus (0.8560 vs. 0.7330, P =0.0427 and 0.8077 vs. 0.5484, P =0.005, respectively)., Conclusions: This study indicated that three-dimensional TEE had a higher diagnostic value than two-dimensional TEE in the detection of thrombus and pannus in patients with LMVO, and can be a reliable imaging modality to identify the causes of LMVO., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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42. Multivalvular involvement associated with Libman-Sacks endocarditis detected by multimodality imaging: A case report.
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Bui STT, Nguyen PH, Nguyen TN, Kirkpatrick JN, Nguyen VK, and Nguyen HTT
- Abstract
Libman-Sacks endocarditis accounts for 6-11 percent of systemic lupus erythematosus patients and is associated with varying degrees of valvular dysfunction, increased risk for stroke and transient ischemic attacks, and increased mortality. In previous studies, left-sided valvular Libman-Sacks vegetations were more frequently detected than right sided vegetations; reported cases of bilateral involvement is very rare. A comprehensive clinical assessment and the multimodality imaging is of utmost importance in the management of systemic lupus erythematosus. In this case report, we describe a 31-year-old female patient with uncontrolled systemic lupus erythematosus initially presented with gastrointestinal symptoms but eventually had a vegetation-like structure on the posterior leaflet of the mitral valve which was revealed during routine echocardiography. Two-dimensional/three-dimensional transthoracic and transesophageal echocardiography, cardiac magnetic resonance, and cardiac computed tomography further characterized the mitral valve vegetation and revealed an additional vegetation of the pulmonary valve. Echocardiography remains the cornerstone for the detection of Libman-Sacks vegetations. Cardiac MRI and cardiac CT are useful in characterizing lesion size and effects and may prove particularly helpful in the assessment of right-sided or multivalvular endocarditis. The presence of focal brain lesions on brain MRI prompted antithrombotic therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Bui, Nguyen, Nguyen, Kirkpatrick, Nguyen and Nguyen.)
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- 2023
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43. The Case for Cardioethics: Applying Practical Ethics to Divisive Challenges in Contemporary Cardiology.
- Author
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Hull SC, Mullen JB, and Kirkpatrick JN
- Abstract
Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Published
- 2023
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44. Cardiac metastasis mimicking STEMI-impact of point-of-care ultrasound on clinical decision-making: A case report.
- Author
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Le AN, Nguyen AV, Nguyen TN, Kirkpatrick JN, Nguyen HT, and Nguyen HTT
- Abstract
Introduction: The manifestations of cardiac metastases are extremely variable depending on their location and extension., Case Presentation: A 62-year-old man was admitted to the cardiac emergency department presenting with chest pain, worsening shortness of breath and palpitations. He had a history of esophageal squamous cell carcinoma treated with chemoradiotherapy, and he was not diagnosed with cardiovascular disease before. The electrocardiogram showed significant ST-segment elevations in leads II, III, and aVF. Initially, the patient was diagnosed with ST-segment elevation myocardial infarction. A cardiac point-of-care ultrasound was performed immediately revealing two large heterogeneous masses in the left ventricular wall and the apex, which changed the diagnosis and the management strategy. There was no significant change in serial cardiac biomarkers in the setting of persistent STE. Thoracic computed tomography and cardiac magnetic resonance confirmed that the patient was suffering from cardiac and lung metastases., Conclusion: ECG findings of localized and prolonged STE without Q waves or changes in biomarkers may suggest myocardial tumor invasion, especially in the cancer setting. Cardiac point-of-care ultrasound is an effective, convenient, noninvasive imaging modality to guide real-time clinical decision-making., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Le, Nguyen, Nguyen, Kirkpatrick, Nguyen and Nguyen.)
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- 2023
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45. Normative values of the aortic valve area and Doppler measurements using two-dimensional transthoracic echocardiography: results from the Multicentre World Alliance of Societies of Echocardiography Study.
- Author
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Cotella JI, Miyoshi T, Mor-Avi V, Addetia K, Schreckenberg M, Sun D, Slivnick JA, Blankenhagen M, Hitschrich N, Amuthan V, Citro R, Daimon M, Gutiérrez-Fajardo P, Kasliwal R, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Tude Rodrigues AC, Ronderos R, Sadeghpour A, Scalia G, Takeuchi M, Tsang W, Tucay ES, Zhang M, Prado AD, Asch FM, and Lang RM
- Subjects
- Male, Humans, Female, Aged, Echocardiography methods, Ultrasonography, Doppler, Heart Ventricles diagnostic imaging, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnostic imaging
- Abstract
Aims: Aortic valve area (AVA) used for echocardiographic assessment of aortic stenosis (AS) has been traditionally interpreted independently of sex, age and race. As differences in normal values might impact clinical decision-making, we aimed to establish sex-, age- and race-specific normative values for AVA and Doppler parameters using data from the World Alliance Societies of Echocardiography (WASE) Study., Methods and Results: Two-dimensional transthoracic echocardiographic studies were obtained from 1903 healthy adult subjects (48% women). Measurements of the left ventricular outflow tract (LVOT) diameter and Doppler parameters, including AV and LVOT velocity time integrals (VTIs), AV mean pressure gradient, peak velocity, were obtained according to ASE/EACVI guidelines. AVA was calculated using the continuity equation. Compared with men, women had smaller LVOT diameters and AVA values, and higher AV peak velocities and mean gradients (all P < 0.05). LVOT and AV VTI were significantly higher in women (P < 0.05), and both parameters increased with age in both sexes. AVA differences persisted after indexing to body surface area. According to the current diagnostic criteria, 13.5% of women would have been considered to have mild AS and 1.4% moderate AS. LVOT diameter and AVA were lower in older subjects, both men and women, and were lower in Asians, compared with whites and blacks., Conclusion: WASE data provide clinically relevant information about significant differences in normal AVA and Doppler parameters according to sex, age, and race. The implementation of this information into clinical practice should involve development of specific normative values for each ethnic group using standardized methodology., Competing Interests: Conflict of interest: M.S., M.B. and N.H. are employees of TOMTEC Imaging Systems. No other direct conflicts of Interest related to this study have been reported by any of the authors., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2023
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46. Scoping review of echocardiographic parameters associated with diagnosis and prognosis after resuscitated sudden cardiac arrest.
- Author
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Liu L, Karatasakis A, Kudenchuk PJ, Kirkpatrick JN, Sayre MR, Carlbom DJ, Johnson NJ, Probstfield JL, Counts C, and Branch KRH
- Subjects
- Adult, Humans, Stroke Volume, Echocardiography, Prognosis, Death, Sudden, Cardiac etiology, Ventricular Function, Left, Heart Arrest complications, Heart Arrest therapy
- Abstract
Aim: Current international guidelines recommend early echocardiography after resuscitated sudden death despite limited data. Our aim was to analyze published data on early post-resuscitation echocardiography to identify cardiac causes of sudden death and prognostic implications., Methods: We reviewed MEDLINE, EMBASE, and CENTRAL databases to December 2021 for echocardiographic studies of adult patients after resuscitation from non-traumatic sudden death. Studies were included if echocardiography was performed <48 hours after resuscitation and reported (1) diagnostic accuracy to detect cardiac etiologies of sudden death or (2) prognostic outcomes. Diagnostic endpoints were associations of regional wall motion abnormalities (RWMA), ventricular function, and structural abnormalities with cardiac etiologies of arrest. Prognostic endpoints were associations of echocardiographic findings with survival to hospital discharge and favorable neurological outcome., Results: Of 2877 articles screened, 16 (0.6%) studies met inclusion criteria, comprising 2035 patients. Two of six studies formally reported diagnostic accuracy for echocardiography identifying cardiac etiology of arrest; RWMA (in 5 of 6 studies) were associated with presumed cardiac ischemia in 17-89% of cases. Among 12 prognostic studies, there was no association of reduced left ventricular ejection fraction with hospital survival (v10) or favorable neurologic status (n = 5). Echocardiographic high mitral E/e' ratio (n = 1) and right ventricular systolic dysfunction (n = 2) were associated with poor survival., Conclusion: This scoping review highlights the limited data on early echocardiography in providing etiology of arrest and prognostic information after resuscitated sudden death. Further research is needed to refine the clinical application of early echocardiographic findings in post arrest care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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47. Multichamber Strain Predicts Atrial Fibrillation in Cardiac Amyloidosis.
- Author
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Yogeswaran V, Singulane CC, Slivnick JA, Kirkpatrick JN, Addetia K, Lang RM, Vasbinder A, Liu JE, Maurer MS, and Cheng RK
- Subjects
- Humans, Heart Atria, Atrial Fibrillation diagnostic imaging, Amyloidosis complications, Amyloidosis diagnosis
- Published
- 2023
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48. Recognized and Unrecognized Value of Echocardiography in Guideline and Consensus Documents Regarding Patients With Chest Pain.
- Author
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Sorrell VL, Lindner JR, Pellikka PA, Kirkpatrick JN, and Muraru D
- Subjects
- Humans, Consensus, Chest Pain diagnostic imaging, Chest Pain etiology, Dyspnea, Echocardiography, Myocardial Ischemia
- Abstract
Guideline and consensus documents have recently been published on the important topic of the noninvasive evaluation of patients presenting with chest pain (CP) or patients with known acute or chronic coronary syndromes. Authors for these documents have included members representing multispecialty imaging societies, yet the process of generating consensus and the need to produce concise written documents have led to a situation where the particular advantages of echocardiography are overlooked. Broad guidelines such as these can be helpful when it comes to "when to do" noninvasive cardiac testing, but they do not pretend to offer nuances on "how to do" noninvasive cardiac testing. This report details the particular value of echocardiography and potential explanations for its understated role in recent guidelines. This report is categorized into the following sections: (1) impact of the level of evidence on guideline creation; (2) versatility of echocardiography in the assessment of CP and the inimitable role for echo Doppler echocardiography in the assessment of dyspnea; (3) value of point-of-care ultrasound in assessing CP and dyspnea; and (4) the future role of echocardiography in ischemic heart disease., (Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
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- 2023
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49. The ASEF: "Together, We Can Make a World of Difference!"
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Kirkpatrick JN and Little SH
- Published
- 2023
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50. Concomitant intramyocardial and hepatic hydatid cysts diagnosed by multi-modality imaging: A rare case report.
- Author
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Nguyen HTT, Pham VT, Duong HD, Kirkpatrick JN, Taylor WR, and Pham HM
- Abstract
Cardiac echinococcosis is a potentially fatal form of hydatid disease; yet, its diagnosis and treatment are challenging due to the variability in its clinical manifestations and due to its various unpredictable preoperative complications. Multi-modality imaging is shown to provide important guidance for the treatment and decision-making. We report a rare case of a 50-year-old woman who had concomitant cardiac and hepatic hydatid cysts. She presented with abdominal pain and elevated eosinophilic white blood cells. The initial abdominal ultrasound and computerized tomography revealed a large cyst in the liver. An intramyocardial cyst was detected by two-dimensional echocardiography. Three-dimensional echocardiography increased the confidence level of two-dimensional echocardiography by displaying the three-dimensional volume of the cyst and allowing visualization of its spatial characteristics and the relationships with adjacent cardiac structures, which was subsequently confirmed at surgery. Multi-detector computed tomography and magnetic resonance imaging helped localize and define the typical morphological features of the cyst. Serology and antigen detection were used for diagnosis. This rare case underlines the integration of clinical, multi-modality imaging, and pathological data in the diagnosis of concomitant intramyocardial and hepatic hydatid cysts. Surgical resection of cysts and anthelmintic medication were successful in the management of this patient., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nguyen, Pham, Duong, Kirkpatrick, Taylor and Pham.)
- Published
- 2022
- Full Text
- View/download PDF
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