Effect of Race on Echocardiographic Measures of Cardiac Structure and Function.

The relations between race and cardiac structure and function are incompletely understood. We hypothesized that race-specific differences in echocardiography measurements exist. We compared the relation between echocardiography measurements and race among 12,429 nonobese adults without known cardiovascular disease who underwent echocardiography.

Differences in Echocardiographic Measures of Aortic Dimensions by Race.

It is not clear whether there are differences in aortic dimensions by race. Our hypothesis was that race-specific differences in aortic size exist. We compared the relation between race and aortic dimensions among 15,295 adults without known risk factors for cardiovascular disease or aortic dilatation, who underwent clinically indicated transthoracic echocardiography.

Indexing left ventricular wall thickness to body surface area improves prognostic value.

Background: Guidelines provide normal ranges of left ventricular (LV) wall thicknesses (WT) without indexing. We hypothesized that indexing WT to body surface area (BSA) improves prognostic value.

Methods: We examined the relationship between WT and BSA in 9737 patients undergoing echocardiography without risk factors for LV hypertrophy other than obesity.

Usefulness of Echocardiography/Doppler to Reliably Predict Elevated Left Ventricular End-Diastolic Pressure in Patients With Pulmonary Hypertension.

The ability of echocardiography (echo)/Doppler to predict elevated left ventricular (LV) end-diastolic pressure (EDP) specifically among patients with pulmonary hypertension is not well defined. This was a retrospective analysis of 161 patients referred to a specialized pulmonary hypertension clinic. A model based on an American Society of Echocardiography (ASE)/European Association of Echocardiography (EAE) joint statement was evaluated, and a new model was developed using univariate linear regression and multivariable logistic regression for potentially better prediction of elevated LVEDP.

Randomized comparison of exercise haemodynamics of Freestyle, Magna Ease and Trifecta bioprostheses after aortic valve replacement for severe aortic stenosis.

Objectives: The purpose of this study was to compare haemodynamics at rest and during exercise after clinically indicated aortic valve replacement (AVR) for aortic stenosis among patients randomly assigned to one of three haemodynamically excellent bioprostheses.

Methods: In a single-centre, prospective trial, 60 patients undergoing clinically indicated AVR were randomly assigned to Freestyle, Magna Ease or Trifecta bioprostheses. Six months after surgery, patients underwent supine bicycle stress echocardiography for the assessment of aortic valve haemodynamics.

A Pharmacy Blueprint for Electronic Medical Record Implementation Success.

Objective: Implementation of an integrated, electronic medical record (EMR) has been promoted as a means of improving patient safety and quality. While there are a few reports of such processes that incorporate computerized prescriber order entry, pharmacy verification, an electronic medication administration record (eMAR), point-of-care barcode scanning, and clinical decision support, there are no published reports on how a pharmacy department can best participate in implementing such a process across a multihospital health care system.

Method: This article relates the experience of the design, build, deployment, and maintenance of an integrated EMR solution from the pharmacy perspective.

Mortality Predictors in Patients Referred for but Not Undergoing Transcatheter Aortic Valve Replacement.

Although transcatheter aortic valve replacement (TAVR) has expanded the proportion of patients with aortic stenosis (AS) who are candidates for valve replacement, some patients remain untreated, and their outcomes are not clear. We evaluated 172 consecutive patients with severe symptomatic AS referred for TAVR who declined (n = 55) or were not candidates for (n = 117) intervention. We examined clinical and echocardiographic variables associated with mortality.

Cor triatriatum: a reversible cause of severe pulmonary hypertension.

Cor triatriatum sinister is a congenital heart disorder that can lead to progressive dyspnea, pulmonary hypertension, and ultimately right ventricular (RV) failure. We report a case in which symptoms of progressive pulmonary hypertension were initially attributed to asthma, leading to a delayed diagnosis that resulted in suprasystemic pulmonary pressures and RV dysfunction. Rapid symptomatic and hemodynamic improvement was observed after surgical repair, with normalization of pulmonary artery pressures and RV function.

Reliable exclusion of acute coronary syndrome among hospitalized patients with elevated troponin.

Background: Elevated cardiac troponin I (cTnI) occurs in acute coronary syndrome (ACS) as well as various scenarios not associated with ACS.

Hypothesis: Simple clinical criteria can reliably exclude ACS among hospitalized patients with elevated cTnI.

Methods: Records for patients hospitalized from January to April 2011 with elevated cTnI (>0.

Long-term clinical outcomes 15 years after aortic valve replacement with the Freestyle stentless aortic bioprosthesis.

Background: The Freestyle stentless aortic root bioprosthesis has excellent hemodynamics and durability through 10 years. The purpose of this report is to present clinical outcomes in a large multicenter cohort through 15 years.

Methods: The multicenter evaluation of the Freestyle valve began in 1992 at 21 centers in North America and Europe.

Sildenafil preserves exercise capacity in patients with idiopathic pulmonary fibrosis and right-sided ventricular dysfunction.

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with pulmonary vasculopathy.

Objective: The purpose of this study was to determine whether sildenafil improves 6-min walk distance (6MWD) in subjects with IPF and right ventricular dysfunction.

Methods: The IPFnet, a network of IPF research centers in the United States, conducted a randomized trial examining the effect of sildenafil on 6MWD in patients with advanced IPF, defined by carbon monoxide diffusing capacity < 35% predicted.

Heart valve disease.

Heart valve disease is often characterized by a prolonged asymptomatic period that lasts for years and presents primary care physicians with an opportunity to detect disease before irreversible heart failure or other cardiac complications develop. Acute valvular disease can masquerade as respiratory illness or present with nonspecific systemic symptoms, and an astute examination by a primary care physician can direct appropriate care. Therefore, an understanding of the common pathologies and presentations of valvular heart disease is critical.

The impact of percutaneous coronary intervention on ischemic mitral regurgitation.

Background And Aim Of The Study: The study aim was to determine if significant ischemic mitral regurgitation (IMR) is adequately addressed in patients undergoing multi-vessel percutaneous coronary intervention (PCI).

Methods: The cardiac catheterization laboratory database at the authors' institution was accessed over a five-year interval to identify those patients who had undergone multi-vessel PCI. Both, pre- and post-revascularization echocardiographic data were retrieved, and clinical data, MR presence and severity, and outcomes were each assessed.

Mitral valve prolapse with left atrial enlargement out of proportion to mitral regurgitation.

Chronic severe mitral regurgitation (MR) is associated with compensatory dilation of the left atrium (LA) and left ventricle (LV). However, LA enlargement is not unique to patients with MR. Herein are reported the details of nine patients with mitral valve prolapse (MVP) and no more than mild MR, but in whom the LA enlargement is out of proportion to the MR severity.

In vitro assessment of prosthesis type and pressure recovery characteristics: Doppler echocardiography overestimation of bileaflet mechanical and bioprosthetic aortic valve gradients.

Objective: Pressure recovery results in Doppler gradients greater than catheter gradients and is well established in association with bileaflet mechanical aortic valves. Because pressure recovery is influenced by orifice geometry, it might manifest differently with various valve prostheses. If true, then the reliability of Doppler echocardiography for the estimation of aortic valve gradients might be different with different prostheses.

Prevalence and characteristics of unoperated patients with severe aortic stenosis.

Background And Aim Of The Study: Although aortic valve replacement (AVR) is the preferred therapy for severe symptomatic aortic stenosis (AS), a substantial number of patients with indications for surgery do not undergo AVR. The study aim was to address, at multiple geographic locations and practice settings, the prevalence of unoperated patients with severe AS, and to explore potential barriers to intervention.

Methods: The medical records at 10 centers of various size and geographic distribution were reviewed retrospectively to identify patients with clinically severe AS (echocardiography/Doppler mean gradient > or = 40 mm Hg, effective orifice area < 1.

Pilot study of cardiac magnetic resonance imaging for detection of embolic source after ischemic stroke.

Background: Transesophageal echocardiography (TEE) is the standard for evaluating cardioembolic sources of stroke, although many strokes remain cryptogenic after TEE. Cardiac magnetic resonance (CMR) imaging may have advantages over TEE. We performed a prospective pilot study comparing CMR to TEE after stroke to assist in planning future definitive studies.