Non-invasively measured myocardial torsional modulus: Comparison to invasive evaluation of diastolic function.

Background: Left ventricular (LV) diastolic function is a key determinant of cardiac output and impairments of diastolic function can lead to heart failure. Assessment of diastolic function is challenging due to several factors, including the load dependence of ventricular filling. We developed a method using cardiovascular magnetic resonance (CMR) imaging to model the untwisting motion of the LV as a viscoelastic damped oscillator to derive myocardial torsional modulus (µ) and frictional damping characteristics, and hypothesized that the torsional modulus would correlate with invasive measures of LV stiffness.

Electrocardiogram to Determine Mitral and Aortic Valve Opening and Closure.

Purpose: Knowledge of the timing of cardiac valve opening and closing is important in cardiac physiology. The relationship between valve motion and electrocardiogram (ECG) is often assumed, however is not clearly defined. Here we investigate the accuracy of cardiac valve timing estimated using only the ECG, compared to Doppler echocardiography (DE) flow imaging as the gold standard.

Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease.

Background: In 2016, the American Society of Echocardiography (ASE) released guidelines for identifying left ventricular (LV) diastolic dysfunction (DD), but its ability to detect early hemodynamic abnormalities is not well established, especially in the setting of subclinical coronary artery disease (CAD). We hypothesize that the accuracy of ASE categorization of early LVDD is affected by knowledge of whether CAD history is present.

Methods: We studied 34 patients (age 62 ± 7 years) with NYHA class I to II symptoms and with transthoracic echocardiography without findings suggesting myocardial disease (all with preserved LV ejection fraction), who underwent cardiac catheterization with high-fidelity LV pressure measurement.

Risk of Major Adverse Cardiovascular Events and Major Hemorrhage Among White and Black Patients Undergoing Percutaneous Coronary Intervention.

Background Data on racial disparities in major adverse cardiovascular events (MACE) and major hemorrhage (HEM) after percutaneous coronary intervention are limited. Factors contributing to these disparities are unknown. Methods and Results PRiME-GGAT (Pharmacogenomic Resource to Improve Medication Effectiveness-Genotype-Guided Antiplatelet Therapy) is a prospective cohort.

Complete white out of a single transplanted lung in the immediate postoperative period.

Vascular complications are rare but serious events following lung transplantation. Of the potential adverse events post lung transplant, pulmonary vein thrombosis is rare but often fatal. Our case describes a 54 year-old male who underwent single left lung transplantation and suddenly became hemodynamically unstable shortly after the procedure.

Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction.

Background: Accurate noninvasive diagnostic tools for evaluating left ventricular (LV) diastolic dysfunction (LVDD) are limited in preserved LV ejection fraction. We previously proposed the relationship of normalized rate of change in LV torsion shear angle (φ') to corresponding rate of change in LV volume (V') during early diastole (represented as -dφ'/dV') as a measure of LV diastolic function. We prospectively evaluated diagnostic accuracy of -dφ'/dV' in respect to invasive LV parameters.

Left ventricular diastolic function and exercise capacity in community-dwelling adults ≥65 years of age without heart failure.

Left ventricular diastolic dysfunction (LVDD) has been reported to have strong correlation with exercise capacity. However, this relationship has not been studied extensively in community-dwelling older adults. Data on pulse and tissue Doppler echocardiographic estimates of resting early (E) and atrial (A) transmitral peak inflow and early (Em) mitral annular velocities, and six-minute walk test were obtained from 89 community-dwelling older adults (mean age, 74; range, 65-93 years; 54% women), without a history of heart failure.

Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure.

Background: Studies of the effect of right ventricular ejection fraction (RVEF) on outcomes in heart failure (HF) are limited by small sample size and short follow-up.

Methods And Results: We examined the effect of baseline RVEF on outcomes in 2008 Beta-Blocker Evaluation of Survival Trial (BEST) participants with HF and left ventricular ejection fraction or=40% (n=733), 30% to 39% (n=531), 20% to 29% (n=473), and <20% (n=271).

A dual propagation contours technique for semi-automated assessment of systolic and diastolic cardiac function by CMR.

Background: Although cardiovascular magnetic resonance (CMR) is frequently performed to measure accurate LV volumes and ejection fractions, LV volume-time curves (VTC) derived ejection and filling rates are not routinely calculated due to lack of robust LV segmentation techniques. VTC derived peak filling rates can be used to accurately assess LV diastolic function, an important clinical parameter. We developed a novel geometry-independent dual-contour propagation technique, making use of LV endocardial contours manually drawn at end systole and end diastole, to compute VTC and measured LV ejection and filling rates in hypertensive patients and normal volunteers.

Mild hyperkalemia and outcomes in chronic heart failure: a propensity matched study.

Background: Compared with serum potassium levels 4-5.5 mEq/L, those <4 mEq/L have been shown to increase mortality in chronic heart failure (HF). Expert opinions suggest that serum potassium levels >5.

The scope of coronary heart disease in patients with chronic kidney disease.

Chronic kidney disease (CKD) affects approximately 13% of the U.S. population and is associated with increased risk of cardiovascular complications.

Oral potassium supplement use and outcomes in chronic heart failure: a propensity-matched study.

Background: Hypokalemia is common in heart failure (HF) and is associated with increased mortality. Potassium supplements are commonly used to treat hypokalemia and maintain normokalemia. However, their long-term effects on outcomes in chronic HF are unknown.

Systolic dysfunction portends increased mortality among those waiting for renal transplant.

Individuals waiting for a renal transplant experience excessive cardiovascular mortality, which is not fully explained by the prevalence of ischemic heart disease in this population. Overt heart failure is known to increase the mortality of patients with ESRD, but the impact of lesser degrees of ventricular systolic dysfunction is unknown. For examination of the association between left ventricular ejection fraction(LVEF) and mortality of renal transplant candidates, the records of 2718 patients evaluated for transplantation at one institution were reviewed.

Predictors of survival in patients with end-stage renal disease evaluated for kidney transplantation.

Cardiovascular disease is the major cause of mortality in patients with end-stage renal disease (ESRD). This study examined the all-cause mortality in 3,698 patients with ESRD evaluated for kidney transplantation at our institution from 2001 to 2004. Mean age for the cohort was 48+/-12 years, and 42% were women.

Origin of all three major coronary arteries from the right sinus of Valsalva: clinical, angiographic, and magnetic resonance imaging findings and incidence in a select referral population.

Objective: We sought to determine the incidence and imaging features by coronary angiography and cardiac magnetic resonance imaging (MRI) of anomalies in which the right, circumflex, and left anterior descending coronary arteries arise separately from the right sinus of Valsalva.

Background: The anomalous origin of all major coronary arteries from separate ostia in the right sinus of Valsalva has been reported as exceedingly rare, with mainly isolated cases reported. A knowledge of the origin and proximal courses of aberrant arteries is critical for patient management.

Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study.

Chronic kidney disease (CKD) is common and is associated with increased mortality in heart failure (HF). However, it is unknown whether the effect of CKD on mortality varies by left ventricular ejection fraction (LVEF). We evaluated the effect of CKD on mortality in patients with systolic (LVEF 45%) HF.

Outcomes in ambulatory chronic systolic and diastolic heart failure: a propensity score analysis.

Background: Prior studies demonstrating significant difference in outcomes in systolic and diastolic heart failure (HF) are often limited to hospitalized acute HF patients, and may be confounded by residual bias. In this analysis, we examined long-term mortality and hospitalization in a propensity score matched cohort of ambulatory chronic systolic and diastolic HF patients.

Methods: Of the 7788 patients in the Digitalis Investigation Group trial, 6800 had systolic HF (ejection fraction >45%) and 988 had diastolic HF (ejection fraction >45%).

Eplerenone prevents adverse cardiac remodelling induced by pressure overload in atrial natriuretic peptide-null mice.

1. Atrial natriuretic peptide (ANP)-null mice (Nppa(-/-)) exhibit cardiac hypertrophy at baseline and adverse cardiac remodelling in response to transverse aortic constriction (TAC)-induced pressure overload stress. Previous studies have suggested that natriuretic peptides could potentially oppose mineralocorticoid signalling at several levels, including suppression of adrenal aldosterone production, inhibition of mineralocorticoid receptor (MR) activation or suppression of MR-mediated production of pro-inflammatory factors.

Incident atrial fibrillation and mortality in older adults with heart failure.

We studied 944 hospitalized heart failure patients 65 years and older to examine the impact of incident atrial fibrillation on mortality. Patients were categorized into four groups based on past medical history and admission electrocardiogram: (1) no (neither past nor current), (2) incident (newly diagnosed), (3) past and (4) chronic (past and current) atrial fibrillation. The primary outcome was 4-year all-cause mortality.

A propensity score analysis of the impact of angiotensin-converting enzyme inhibitors on long-term survival of older adults with heart failure and perceived contraindications.

Objectives: The purpose of this study is to determine the association between discharge use of angiotensin-converting enzyme (ACE) inhibitors in patients with perceived contraindications to these drugs and 4-year post-discharge survival among hospitalized older adults discharged alive with a primary discharge diagnosis of systolic heart failure.

Background: Perceived contraindications to the use of ACE inhibitors are often associated with underuse of these life-saving drugs.

Methods: Chronic renal insufficiency, hypotension, hyperkalemia, and severe aortic stenosis were conditions perceived as contraindications.

Impact of atrial fibrillation on mortality and readmission in older adults hospitalized with heart failure.

Background: Atrial fibrillation is common in older adults with heart failure. It is known to adversely affect outcomes.

Aim: To examine the associations of atrial fibrillation with 4-year mortality and 30-day readmission in older adults hospitalized with heart failure.

Volume overload results in exaggerated cardiac hypertrophy in the atrial natriuretic peptide knockout mouse.

Objective: Previous studies suggest that atrial natriuretic peptide (ANP) may act as an autocrine/paracrine factor to modulate cardiac hypertrophy in response to various stimuli. The effect of ANP deficiency on the response to volume overload has not previously been studied. We hypothesised that ANP deficient mice would develop excess cardiac hypertrophy in response to volume overload stress.

Prevalence of renal artery stenosis in high-risk veterans referred to cardiac catheterization.

Objective: The prevalence of atherosclerotic renal artery stenosis (RAS) varies depending on patient selection with no specific guidelines on indications for selective renal angiography in patients referred for coronary angiography. The goal of this study is to determine the prevalence and predictors of renal artery stenosis in hypertensive veterans referred for coronary angiography.

Design: Prospective study.

Angiotensin II receptor blockade does not improve left ventricular function and remodeling in subacute mitral regurgitation in the dog.

Objectives: We hypothesized that angiotensin II type-1 (AT(1)) receptor blocker (AT(1)RB) would prevent adverse left ventricular (LV) remodeling and LV dysfunction when started at the outset of mitral regurgitation (MR).

Background: Little is known regarding the efficacy of AT(1)RB treatment of MR.

Methods: Mitral regurgitation was induced by chordal disruption in adult mongrel dogs.