Who is young at heart and when? Diastolic Doppler data from the mind your heart study.

To further define the age-related distribution of diastolic function as defined by E/A ratio, in healthy male adults. The age-sensitive ratio of mitral inflow E-wave to A-wave (E/A) velocity is often considered in the evaluation of diastolic function. To appropriately direct a comprehensive evaluation of diastolic function, we sought to improve the characterization of the influence of age on E/A ratio.

Relationship of Bisphosphonate Therapy and Atrial Fibrillation/Flutter: Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study.

Background: Prior studies suggested an association between bisphosphonates and atrial fibrillation/flutter (AF) in women. This relationship in men, including those with sleep-disordered breathing (SDB), remains unclear. This study evaluated the relationship between bisphosphonate use and prevalent (nocturnal) and incident (clinically relevant) AF in a population of community-dwelling older men.

Left ventricular outflow tract and pulmonary artery stroke distances independently predict heart failure hospitalization and mortality: the Heart and Soul Study.

Background: Stroke distance of the left ventricular outflow tract (LVOT) or pulmonary artery (PA) is readily measurable by Doppler echocardiography. Stroke distance, calculated by the velocity time integral, expresses the average linear distance traveled by red blood cells during systole. We hypothesized that reduced stroke distance predicts heart failure (HF) hospitalization or mortality among ambulatory adults with stable coronary artery disease.

Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: survival without reoperation.

Background: the tissue spanning the mitral and aortic valves, the mitral-aortic intervalvular fibrosa (MAIVF), may be the site of pseudoaneurysm formation in the setting of infective endocarditis or congenital heart disease, or after valve surgery. Because of potential complications of MAIVF pseudoaneurysms, patients with such lesions are often referred for surgical repair.

Methods: we identified 3 individuals with MAIVF pseudoaneurysms who were followed without surgical intervention after diagnosis of the MAIVF pseudoaneurysm.

Obtaining accurate hemodynamics from echocardiography: achieving independence from right heart catheterization.

Purpose Of Review: Accurate noninvasive evaluation of right heart hemodynamics is an essential component of the comprehensive cardiac examination. We aim to highlight recent advances in echocardiography allowing integration of measurements to obtain diagnostic accuracy.

Recent Findings: Reports have advocated different imaging methods to describe right ventricular function and pulmonary artery pressure.

Predicting heart failure hospitalization and mortality by quantitative echocardiography: is body surface area the indexing method of choice? The Heart and Soul Study.

Background: Echocardiographic measurements of left ventricular (LV) mass, left atrial (LA) volume, and LV end-systolic volume (ESV) predict heart failure (HF) hospitalization and mortality. Indexing measurements by body size is thought to establish limits of normality among individuals varying in body habitus. The American Society of Echocardiography recommends dividing measurements by body surface area (BSA), but others have advocated alternative indexing methods.

Usefulness of diastolic dominant pulmonary vein flow to predict hospitalization for heart failure and mortality in ambulatory patients with coronary heart disease (from the Heart and Soul Study).

Diastolic dysfunction is usually identified by the combination of characteristic mitral and pulmonary vein flow patterns. However, obtaining a complete set of echocardiographic parameters can be technically difficult and data may conflict. We hypothesized that as a stand-alone variable, (ventricular) diastolic dominant pulmonary vein flow would predict heart failure (HF) hospitalizations and cardiovascular death.

Usefulness of left atrial volume index to predict heart failure hospitalization and mortality in ambulatory patients with coronary heart disease and comparison to left ventricular ejection fraction (from the Heart and Soul Study).

The predictive value of left atrial (LA) dilatation in ambulatory adults with coronary artery disease is not known. It was hypothesized that echocardiographic LA volume index (LAVI) predicts heart failure (HF) hospitalization and mortality with similar statistical power as left ventricular ejection fraction (LVEF) in ambulatory adults with coronary artery disease. We measured LAVI in 935 adults without atrial fibrillation, atrial flutter, or significant mitral valve disease in the Heart and Soul Study.

Improvement in dilated cardiomyopathy after bariatric surgery.

Background: Young severely obese patients with advanced heart failure may not be suitable candidates for cardiac transplantation because of surgical morbidity and availability of adequately sized donor hearts.

Methods And Results: We report 2 patients with severe systolic dysfunction and Class IV heart failure despite maximal medical therapy who were considered for cardiac transplantation. Because of their severe obesity, transplantation was not considered an optimal therapy, and both were referred for bariatric surgery.

Association of African American race with elevated pulmonary artery diastolic pressure: data from the Heart and Soul Study.

Background: Whether increased severity of heart failure in African Americans is a result of differences in cardiac physiology is uncertain. The end-diastolic pulmonary regurgitation (EDPR) gradient is associated with abnormal cardiac physiology. We hypothesized that African American race is associated with an elevated EDPR gradient that may partially predispose African Americans to heart failure.

Prevalence and prognosis of asymptomatic left ventricular diastolic dysfunction in ambulatory patients with coronary heart disease.

The association of asymptomatic left ventricular (LV) diastolic dysfunction with cardiovascular outcomes in ambulatory patients with coronary heart disease (CHD) and no history of heart failure (HF) was examined. LV diastolic HF predicts adverse cardiovascular outcomes. However, the prevalence and prognosis of asymptomatic LV diastolic dysfunction in patients with established CHD in the absence of clinical HF is unknown.

Overwhelming parasitemia with Plasmodium falciparum infection in a patient receiving infliximab therapy for rheumatoid arthritis.

We describe a 45-year-old woman receiving infliximab therapy for rheumatoid arthritis who developed an overwhelming Plasmodium falciparum infection with cerebral malaria. Physicians should be aware that patients receiving tumor necrosis factor inhibitors, such as infliximab, may be at increased risk of life-threatening malarial infections.

Acute myocardial infarction in patients with versus without aortic valve sclerosis and effect of statin therapy (from the Heart and Soul Study).

Aortic sclerosis is associated with cardiovascular events in patients without coronary heart disease (CHD), but it is unclear whether this association exists in patients with established CHD or is independent of baseline cardiac disease severity. It is also unclear whether statins modify this association. In a prospective cohort study of 814 outpatients with established CHD and no evidence of aortic stenosis, the association of aortic sclerosis with subsequent cardiovascular events was examined using a multivariable Cox proportional hazards model.

Elevated pulmonary artery pressure by Doppler echocardiography predicts hospitalization for heart failure and mortality in ambulatory stable coronary artery disease: the Heart and Soul Study.

Objectives: We compared the predictive ability of tricuspid regurgitation (TR) and end-diastolic pulmonary regurgitation (EDPR) gradients in outpatients with coronary artery disease.

Background: The TR and EDPR gradients, in conjunction with right atrial pressure, provide Doppler estimates of pulmonary artery systolic and diastolic pressures. We hypothesized that increases in TR or EDPR gradients in stable coronary artery disease would predict heart failure (HF) hospitalization or cardiovascular (CV) death.

Pulmonary regurgitation end-diastolic gradient is a Doppler marker of cardiac status: data from the Heart and Soul Study.

Background: Echocardiograms routinely sample pulmonary regurgitation signals from which it is possible to measure end diastolic gradients; these correlate with pulmonary artery diastolic pressures.

Methods: We performed echocardiograms in 741 ambulatory adults with coronary artery disease who were recruited for the Heart and Soul Study. We compared indicators of cardiac status among individuals with normal (0-5.