Implementation of a Clinical Decision Support Tool to Improve Cardiac Rehabilitation Referral.

Purpose: Inadequate referral to cardiac rehabilitation (CR) is a major barrier to CR participation. We investigated the implementation of a clinical decision support (CDS) tool on improving CR referral for patients hospitalized with acute myocardial infarction (AMI) at an academic medical center.

Methods: We developed a CDS tool that identified patients admitted with AMI and reminded physicians to refer patients to CR.

Emerging Educational and Networking Platforms in Interventional Cardiology: Expanding Beyond Traditional Social Media.

With ubiquitous use of smartphones and other Internet-enabled devices, clinicians have access to a plethora of multimedia platforms that enable them to network, share educational content, and learn. Several platforms also enable resources that support clinical decision making. Traditional social media has been used extensively by cardiologists for several years and now extends to the entire care team including trainees, advanced practitioners, nurses and technologists.

Spectral analysis of non-contrast fluoroscopy for evaluation of pulmonary perfusion: Feasibility and sensitivity testing with a phantom.

Background: Oscillating x-ray attenuation in the lungs provides an opportunity to evaluate pulmonary perfusion without contrast. Recent intensity-based methods have been compared to pulmonary scintigraphy and CT angiography but lack rigorous phantom studies.

Purpose: A new method to quantify the periodic signal amplitude was employed using spectral analysis.

Treatment of Severe Symptomatic Aortic Stenosis During Pregnancy: A Potential Role for TAVR?

A 35-year-old woman presented at 22 weeks gestation with severe symptomatic aortic stenosis with a mean gradient of 94 mm Hg and an aortic valve area of 0.53 cm. After multidisciplinary discussion, she underwent transcatheter aortic valve replacement during pregnancy.

A Deep Learning Framework Discovers Compositional Order and Self-Assembly Pathways in Binary Colloidal Mixtures.

Binary colloidal superlattices (BSLs) have demonstrated enormous potential for the design of advanced multifunctional materials that can be synthesized via colloidal self-assembly. However, mechanistic understanding of the three-dimensional self-assembly of BSLs is largely limited due to a lack of tractable strategies for characterizing the many two-component structures that can appear during the self-assembly process. To address this gap, we present a framework for colloidal crystal structure characterization that uses branched graphlet decomposition with deep learning to systematically and quantitatively describe the self-assembly of BSLs at the single-particle level.

Modeling the impact of delaying transcatheter aortic valve replacement for the treatment of aortic stenosis in the era of COVID-19.

Objective: The aim of this study was to model the short term and 2-year overall survival (OS) for intermediate-risk and low-risk patients with severe symptomatic aortic stenosis (AS) undergoing timely or delayed transcatheter aortic valve replacement (TAVR) during the 2019 novel coronavirus (COVID-19) pandemic.

Methods: We developed a decision analysis model to evaluate 2 treatment strategies for both low-risk and intermediate-risk patients with AS during the COVID-19 novel coronavirus pandemic.

Results: Prompt TAVR resulted in improved 2-year OS compared with delayed intervention for intermediate-risk patients (0.

Limited Balloon Atrial Septostomy for Left Ventricular Unloading in Peripheral Extracorporeal Membrane Oxygenation.

Background: This study describes the authors' experience with a limited balloon atrial septostomy technique, using a median balloon size of 15 mm, as a left ventricular (LV) unloading strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO). There has been increasing use of VA-ECMO in cardiogenic shock. Although LV unloading strategies have been suggested to improve outcomes, it is unclear which strategy is optimal.

Deep learning for characterizing the self-assembly of three-dimensional colloidal systems.

Creating a systematic framework to characterize the structural states of colloidal self-assembly systems is crucial for unraveling the fundamental understanding of these systems' stochastic and non-linear behavior. The most accurate characterization methods create high-dimensional neighborhood graphs that may not provide useful information about structures unless these are well-defined reference crystalline structures. Dimensionality reduction methods are thus required to translate the neighborhood graphs into a low-dimensional space that can be easily interpreted and used to characterize non-reference structures.

Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement.

Background Gait speed is a reliable measure of physical function and frailty in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Slow gait speed pre-TAVR predicts worse clinical outcomes post-TAVR. The consequences of improved versus worsened physical function post-TAVR are unknown.

Association of Natriuretic Peptide Levels After Transcatheter Aortic Valve Replacement With Subsequent Clinical Outcomes.

Importance: Among those with aortic stenosis, natriuretic peptide levels can provide risk stratification, predict symptom onset, and aid decisions regarding the timing of valve replacement. Less is known about the prognostic significance and potential clinical utility of natriuretic peptide levels measured after valve replacement.

Objective: To determine the associations of elevated B-type natriuretic peptide (BNP) levels after transcatheter aortic valve replacement (TAVR) and change in BNP levels between follow-up time points with risk of subsequent clinical outcomes.

Treatment of Secondary Mitral Regurgitation in Heart Failure: A Shifting Paradigm in the Wake of the COAPT Trial.

Secondary mitral regurgitation (MR) is common in patients with left heart dysfunction and it is associated with poor outcomes. Findings from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, published in 2018, suggest that in a subset of people with heart failure with secondary MR that persists despite optimization of guideline-directed medical therapies, there is now a role for percutaneous mitral valve repair using the MitraClip device. Defining which patients are most likely to benefit from MitraClip, and when, requires both a multidisciplinary approach centered on heart failure, as well as a recognition of the need for further research in this area.

Lower Blood Pressure After Transcatheter or Surgical Aortic Valve Replacement is Associated with Increased Mortality.

Background Blood pressure (BP) guidelines for patients with aortic stenosis or a history of aortic stenosis treated with aortic valve replacement (AVR) match those in the general population, but this extrapolation may not be warranted. Methods and Results Among patients enrolled in the Medtronic intermediate, high, and extreme risk trials, we included those with a transcatheter AVR (n=1794) or surgical AVR (n=1103) who were alive at 30 days. The associations between early (average of discharge and 30 day post-AVR) systolic BP (SBP) and diastolic BP (DBP) measurements and clinical outcomes between 30 days and 1 year were evaluated.

Lack of a Tricuspid Regurgitation Doppler Signal and Pulmonary Hypertension by Invasive Measurement.

Background: Transthoracic echocardiography (TTE) is used to estimate pulmonary artery systolic pressure, but an adequate tricuspid regurgitation velocity (TRV) needed to calculate pulmonary artery systolic pressure is not always present. It is unknown whether the absence of a measurable TRV signifies normal pulmonary artery pressure.

Methods And Results: We extracted hemodynamic, TTE, and clinical data from Vanderbilt's deidentified electronic medical record in all patients referred for right heart catheterization between 1998 and 2014.

Racial differences in patients referred for right heart catheterization and risk of pulmonary hypertension.

African Americans (AA) have a higher incidence of pulmonary hypertension (PH) risk factors. Few studies have examined the racial differences in the prevalence and etiology of PH and direct comparison of invasive hemodynamics between AAs and Caucasians has rarely been reported. In this study, we examined whether racial differences exist in patients referred for right heart catheterization (RHC) and hypothesized that AA race is an independent risk factor for PH and is associated with increased adjusted mortality.

Engineering of a miniaturized, robotic clinical laboratory.

The ability to perform laboratory testing near the patient and with smaller blood volumes would benefit patients and physicians alike. We describe our design of a miniaturized clinical laboratory system with three components: a hardware platform (ie, the miniLab) that performs preanalytical and analytical processing steps using miniaturized sample manipulation and detection modules, an assay-configurable cartridge that provides consumable materials and assay reagents, and a server that communicates bidirectionally with the miniLab to manage assay-specific protocols and analyze, store, and report results (i.e.

Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes.

Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) and associated with increased mortality but the hemodynamic profiles, clinical risk factors, and outcomes have not been well characterized. Our objective was to define the hemodynamic profile and related risk factors for PH in CKD patients. We extracted clinical and hemodynamic data from Vanderbilt's de-identified electronic medical record on all patients undergoing right heart catheterization during 1998-2014.

Lithotripsy stimulates new bone formation and mitigates loss of bone due to disuse in aged rats.

Background: Normal "wear and tear" of bones during weight bearing activity creates microdamage that triggers bone to heal itself.

Objective: A controlled laboratory study was carried out to determine the effect of lithotripsy on bone apposition and resorption in osteopenic, hind-limb suspended, aged rats compared to age-matched controls allowed normal weight bearing (cage) activity.

Methods: First, we tested the feasibility of using a clinical lithotripsy device, designed for treatment of kidney stones, to create microdamage in bone.