Association of Albuminuria With Cardiac Dysfunction in US Hispanics/Latinos.

Higher urine albumin-to-creatinine ratio (UACR) has been associated with cardiac dysfunction in the general population. We assessed the association of UACR with cardiac structure and function in the Echocardiographic Study of Latinos (Echo-SOL), an ancillary study of the Hispanic Community Health Study/Study of Latinos across 4 US sites. Echo-SOL participants underwent standard 2-dimensional echocardiography, including speckle-tracking strain analysis.

Hemodynamic evaluation of suspected severe aortic stenosis leads to a diagnosis of renal cell carcinoma.

The evaluation of aortic stenosis is not always straightforward. When symptoms of severe aortic stenosis are present with supporting Doppler echocardiographic or cardiac catheterization data, replacement of the aortic valve is recommended. Occasionally, Doppler- and catheter-derived data are discordant; appropriate treatment in such cases becomes less clear.

Reversal of end stage renal disease in patient with transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) has become an alternative intervention in high-risk and inoperable patients with symptomatic aortic valve stenosis. The procedure has been associated with favorable clinical outcomes and safety profile in patients with end stage renal disease (ESRD). We describe a case of improved kidney function in a patient with ESRD without further need for dialysis after TAVR.

Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves).

Objectives: This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).

Background: The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR.

Methods: Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory.

The transaortic approach for transcatheter aortic valve replacement: initial clinical experience in the United States.

Objectives: This study sought to investigate the technical feasibility and safety of the transaortic (TAO) transcatheter aortic valve replacement (TAVR) approach in patients not eligible for transfemoral (TF) access by using a device commercially available in the United States.

Background: A large proportion of candidates for TAVR have inadequate iliofemoral vessels for TF access. The transapical route (TAP) is the current alternative but is associated with less favorable outcomes.

Management of paravalvular regurgitation after Edwards SAPIEN transcatheter aortic valve replacement: management of paravalvular regurgitation after TAVR.

Background: With the expansion in the use of transcatheter valve therapies for aortic stenosis, the incidence of hemodynamically significant paravalvular regurgitation (PVR) has become a clinical challenge.

Methods: The study population consisted of those patients with either acute significant PVR immediately post-Edwards SAPIEN (ES) aortic valve implantation, requiring additional maneuvers during the index transcatheter aortic valve replacement (TAVR) or symptomatic PVR requiring treatment by transcatheter closure at a later date. All the patients were assessed within 24 hrs, 30 days, 3 months, 6 months and 12 months after the procedure.

A multicenter, randomized, double-blind, placebo-controlled study of tolvaptan monotherapy compared to furosemide and the combination of tolvaptan and furosemide in patients with heart failure and systolic dysfunction.

Background: Increased vasopressin levels may be present in patient with chronic heart failure (HF) and contribute to pathophysiology through effects on the vasopressin V2 receptor. The presence of background diuretic therapy may confound evaluations of vasopressin receptor antagonists (VRA).

Methods And Results: Eligible patients had HF (New York Heart Association Class II-III), systolic dysfunction (left ventricular ejection fraction ≤0.

Central obesity and insulin resistance in the cardiometabolic syndrome: pathways to preclinical cardiovascular structure and function.

The cardiometabolic syndrome (CMS) has been an organizing conceptual framework for subclinical cardiovascular pathophysiology. Using cross-sectional data from 338 healthy men and women aged 18 to 55 years, the study examined the role of central adiposity and insulin sensitivity and assessed potential relationships with other metabolic indices (insulin sensitivity, glucose tolerance, fibrinolysis, lipidemia, endothelial function, and inflammation) and measures of cardiac structure and function (cardiac mass, compliance and contractility, myocardial oxygen demand, and blood pressure). Structural equation modeling analyses, which controlled for sex, age, and race, demonstrated good fit to the data.

Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function.

The study examined whether deficits in cardiac output and blood volume in a CFS (chronic fatigue syndrome) cohort were present and linked to illness severity and sedentary lifestyle. Follow-up analyses assessed whether differences in cardiac output levels between CFS and control groups were corrected by controlling for cardiac contractility and TBV (total blood volume). The 146 participants were subdivided into two CFS groups based on symptom severity data, severe (n=30) and non-severe (n=26), and two healthy non-CFS control groups based on physical activity, sedentary (n=58) and non-sedentary (n=32).

HIV, metabolic syndrome X, inflammation, oxidative stress, and coronary heart disease risk : role of protease inhibitor exposure.

Differences on measures of metabolic syndrome X and coronary heart disease (CHD) risk, as well as potential pathophysiological mediators, inflammation, and oxidative stress, were examined as a function of HIV serostatus and highly active antiretroviral therapy (HAART) regimen with and without protease inhibitors (PIs). Data from 164 men and women, aged 18 to 55 yr, were used to compare 82 HIV+ subjects who were free of hepatitis C virus and were on a stable HAART regimen for >/=6 mo, with 82 seronegative subjects matched on age, sex, body mass index, and ethnicity. For the HIV+ subjects, after controlling for diabetes status and HIV disease progression, PI exposure was associated with greater oxidative stress, triglyceridemia, and lipidemia than it was for non-PI-exposed HIV+ subjects, and the risk of a future myocardial infarction was up to 56% greater in PI-exposed than in non-PI-exposed subjects and 129% greater than in controls.

Thrombosed chamber of cor-triatriatum mimicking left atrial tumor (case report).

Cor-triatriatum is an uncommon congenital cardiac anomaly. In this case report, transesophageal echocardiographic and operative findings in a 57-year-old female with cor-triatriatum are presented.

Effects of omapatrilat on hemodynamics and safety in patients with heart failure.

Omapatrilat, a novel vasopeptidase inhibitor, is a highly potent and selective inhibitor of neutral endopeptidase and angiotensin-converting enzyme; its therapeutic potential is being investigated for treatment of hypertension and heart failure. In the present study, the safety, tolerability, and hemodynamic effects of single oral doses of omapatrilat (1 to 50 mg) are compared with placebo in patients with heart failure. Patients with heart failure (New York Heart Association functional class II to IV) and a resting left ventricular ejection fraction < or = 40% were enrolled in a double-blind, placebo-controlled, sequential-panel study of single doses of omapatrilat of 1, 2.

Primary cardiac lymphoma diagnosed by percutaneous intracardiac biopsy with combined fluoroscopic and transesophageal echocardiographic imaging.

Primary cardiac tumors have very low prevalence with cardiac lymphoma, being one of the rarest forms. Several recent reports have shown transesophageal echocardiography to be an accurate technique for characterizing and localizing these neoplasms, with results comparable to CT and MRI scans. Transvenous intracardiac tumor biopsy has been employed as a minimally invasive technique to obtain tissue samples.

Dose-related beneficial long-term hemodynamic and clinical efficacy of irbesartan in heart failure.

Objectives: The primary purpose of this study was to determine the acute and long-term hemodynamic and clinical effects of irbesartan in patients with heart failure.

Background: Inhibition of angiotensin II production by angiotensin-converting enzyme (ACE) inhibitors reduces morbidity and mortality in patients with heart failure. Irbesartan is an orally active antagonist of the angiotensin II AT1 receptor subtype with potential efficacy in heart failure.

Effects of electrically-stimulated exercise and passive motion on echocardiographically-derived wall motion and cardiodynamic function in tetraplegic persons.

The purposes of the study were (1) to characterize left ventricular wall motion, and the cardiodynamic and metabolic responses during electrical stimulation cycle ergometry (ESCE) exercise in tetraplegic people; (2) to test whether these responses linger into the post-exercise recovery period; and (3) to test whether they differ from those imposed by lower extremity continuous passive motion (CPM). Subjects were six tetraplegic males aged 25.8 +/- 3.

Unmasking a patent foramen ovale during recurrent paradoxical cerebral embolism.

A patient with an acute ischemic stroke had an interatrial septal aneurysm shown by transesophageal echocardiography. Interatrial shunting, compatible with a patent foramen ovale, was observed on a follow-up study after a second stroke. This was seen in association with a right atrial thrombus.

Determination of replacement and suppressive doses of thyroxine.

Suppression daily doses of thyroxine (T4) were determined and the daily amounts of T4 required to replace T4 were established in 217 hypothyroid patients. Patients with Hashimoto's thyroiditis treated daily with 2-3 micrograms/kg lean body mass or 1-2 micrograms/kg body weight T4 had normal serum thyrotrophin (TSH) concentrations, normal response to TSH-releasing hormone (TRH) and normal systolic time intervals but doses higher than 3 micrograms/kg lean body mass or 2 micrograms/kg body weight decreased serum TSH concentrations, with no response to TRH and systolic time intervals typical of hyperthyroidism. In 13/32 (41%) hypothyroid patients with Graves' disease following 131I and/or surgery, the daily T4 replacement dose was similar to that in Hashimoto's thyroiditis patients but in 12 (38%) patients daily doses of 2-3 micrograms/kg lean body mass or 1-2 micrograms/kg body weight T4 increased serum T4 and suppressed TSH levels, and in six (9%) lower doses were required to control hypothyroidism.

Evidence of hyperthyroidism in apparently euthyroid patients treated with levothyroxine.

A concentration of serum thyroxine (T4) above the accepted normal range has recently been recognized to result from commonly prescribed replacement dosages of levothyroxine sodium. To determine if the high levels of serum T4 have undesirable metabolic effects, despite the fact that the subjects are accepted as euthyroid, we studied 28 patients receiving long-term levothyroxine therapy; 19 patients were considered to be receiving replacement dosages and nine suppressive dosages of levothyroxine. To assess the effect of levothyroxine on target tissue, we measured the thyrotropin response to protirelin and systolic time intervals obtained by simultaneous electrocardiography and echocardiography.

Cardiovascular findings in quadriplegic and paraplegic patients and in normal subjects.

Seven normal, 7 paraplegic and 7 quadriplegic patients underwent cross-sectional cardiovascular evaluation, including recording of sitting heart rate, blood pressure and echocardiography. Quadriplegic patients had a 26% lower left ventricular (LV) mass index (75 +/- 13 g/m2, p less than 0.01) compared with normal volunteers (102 +/- 16 g/m2) or paraplegic patients (110 +/- 26 g/m2).

Cardiac arrest in an adolescent with atrial fibrillation and hypertrophic cardiomyopathy.

A 15 year old youth, who presented with out-of-hospital cardiac arrest due to documented ventricular fibrillation, was found to have nonobstructive hypertrophic cardiomyopathy. Electrophysiologic study demonstrated inducible sustained atrial fibrillation with a rapid ventricular response. This rhythm, associated with hypotension and evidence of myocardial ischemia, spontaneously degenerated into ventricular fibrillation.