Publications by authors named "Frederick Welt"

Despite impressive improvements in the care of patients with ST-segment elevation myocardial infarction, mortality remains high. Reperfusion is necessary for myocardial salvage, but the abrupt return of flow sets off a cascade of injurious processes that can lead to further necrosis. This has been termed myocardial ischemia-reperfusion injury and is the subject of this review.

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  • Frailty linked to worse outcomes post-transcatheter aortic valve replacement (TAVR) and is often underpinned by sarcopenia, which includes muscle mass, strength, and performance, though their impact on TAVR outcomes hasn't been fully studied.
  • In a study of 445 patients with severe aortic stenosis, significant percentages were found to have slow gait (56%), weak grip (59%), and low muscle mass (42%); only slower gait speed showed a clear link to increased mortality after TAVR.
  • The research indicates that while overall body fat measurements and sarcopenia criteria influence mortality risk, lower visceral fat and slow gait speed are main factors affecting post-TAVR death rates.
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Background: Depression and cognitive dysfunction (CD) are not routinely screened for in patients before transcatheter aortic valve replacement (TAVR) and their association with postprocedural outcomes is poorly understood. The objectives of this study are to determine the prevalence of depression and CD in patients with aortic stenosis undergoing TAVR and evaluate their association with mortality and quality of life.

Methods: We analyzed a prospective, multicenter TAVR registry that systematically screened patients for preexisting depression and CD with the Patient Health Questionnaire-2 and Mini-Cog, respectively.

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  • Research indicates that metabolic dysfunction plays a role in heart changes due to aortic stenosis, but a significant study on human metabolism hasn't been done yet.
  • In a study involving 519 patients, researchers examined 12 heart function metrics before valve implantation and identified three patterns of heart remodeling, linking these to specific metabolic profiles.
  • A distinctive metabolite score for heart function was found to predict higher death rates post-surgery and was related to overall health issues, emphasizing the need to explore metabolic factors to improve patient outcomes after transcatheter aortic valve placement.
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Cardiac catheterization laboratory (CCL) morbidity and mortality conferences (MMCs) are a critical component of CCL quality improvement programs and are important for the education of cardiology trainees and the lifelong learning of CCL physicians and team members. Despite their fundamental role in the functioning of the CCL, no consensus exists on how CCL MMCs should identify and select cases for review, how they should be conducted, and how results should be used to improve CCL quality. In addition, medicolegal ramifications of CCL MMCs are not well understood.

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Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize the performance of PCI. IVI has utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications.

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  • Treatment of left main coronary artery disease (CAD) involves complex decision-making despite available clinical guidelines.
  • The American College of Cardiology's team has developed a practical approach that incorporates data from clinical trials, emphasizing the need for individualized care.
  • A team-based strategy is recommended to consider various factors and ensure shared decision-making that aligns with patient preferences and clinical situations.
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  • Global longitudinal strain (GLS) serves as a measure of left ventricular function, and the study aimed to see if cardiac damage (troponin) and stress (NT-proBNP) biomarkers can enhance GLS effectiveness in identifying high-risk patients with severe aortic stenosis.
  • In a study involving 499 patients who underwent transcatheter aortic valve implantation, it was found that patients with impaired GLS had higher levels of cardiac troponin and NT-proBNP compared to those with normal GLS.
  • The analysis revealed that while lower GLS indicated increased mortality likelihood, the biomarkers of cardiac damage and stress were independently linked to mortality risk, suggesting that these biomarkers may be more reliable for assessing patient risk and timing for valve replacement.
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Background: We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic.

Objectives: The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic.

Methods: The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America.

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Background Left ventricular hypertrophy (LVH) is associated with increased mortality risk and rehospitalization after transcatheter aortic valve replacement among those with severe aortic stenosis. Whether cardiac troponin (cTnT) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) risk stratify patients with aortic stenosis and without LVH is unknown. Methods and Results In a multicenter prospective registry of 923 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, we included 674 with core-laboratory-measured LV mass index, cTnT, and NT-proBNP.

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The purpose of this position statement is to suggest ways in which future appropriate use criteria (AUC) for coronary revascularization might be restructured to: (1) incorporate improvement in quality of life and angina relief as primary goals of therapy, (2) integrate the findings of recent trials into quality appraisal, (3) employ the combined information of the coronary angiogram and invasive physiologic measurements together with the results of stress test imaging to assess risk, and (4) recognize the essential role that patient preference plays in making individualized therapeutic decisions. The AUC is a valuable tool within the quality assurance process; it is vital that interventionists ensure that percutaneous coronary intervention case selection is both evidence-based and patient oriented. Appropriate patient selection is an important quality indicator and adherence to evidence-based practice should be one metric in a portfolio of process and outcome indicators that measure quality.

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Aims: Impaired physical function is common in patients undergoing transcatheter aortic valve replacement (TAVR) and associated with worse outcomes. Participation in centre-based cardiac rehabilitation (CR) after cardiovascular procedures is sub-optimal. We aimed to test a home-based mobile health exercise intervention as an alternative or complementary approach.

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The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular.

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Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI).

Objectives: The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI.

Methods: A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies.

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COVID-19 has disrupted traditional cardiovascular care pathways leading to significant challenges; with these challenges have also come opportunities to iterate our testing strategies to ensure they are patient centered and also that they are most appropriate and best align with infection protection protocols. © RSNA, 2020.

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