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Existing Nongated CT Coronary Calcium Predicts Operative Risk in Patients Undergoing Noncardiac Surgeries (ENCORES)

Choi, Daniel Y; Hayes, Dena; Maidman, Samuel D; Dhaduk, Nehal; Jacobs, Jill E; Shmukler, Anna; Berger, Jeffrey S; Cuff, Germaine; Rehe, David; Lee, Mitchell; Donnino, Robert; Smilowitz, Nathaniel R
BACKGROUND:Preoperative cardiovascular risk stratification before noncardiac surgery is a common clinical challenge. Coronary artery calcium scores from ECG-gated chest computed tomography (CT) imaging are associated with perioperative events. At the time of preoperative evaluation, many patients will not have had ECG-gated CT imaging, but will have had nongated chest CT studies performed for a variety of noncardiac indications. We evaluated relationships between coronary calcium severity estimated from previous nongated chest CT imaging and perioperative major clinical events (MCE) after noncardiac surgery. METHODS:We retrospectively identified consecutive adults age ≥45 years who underwent in-hospital, major noncardiac surgery from 2016 to 2020 at a large academic health system composed of 4 acute care centers. All patients had nongated (contrast or noncontrast) chest CT imaging performed within 1 year before surgery. Coronary calcium in each vessel was retrospectively graded from absent to severe using a 0 to 3 scale (absent, mild, moderate, severe) by physicians blinded to clinical data. The estimated coronary calcium burden (ECCB) was computed as the sum of scores for each coronary artery (0 to 9 scale). A Revised Cardiac Risk Index was calculated for each patient. Perioperative MCE was defined as all-cause death or myocardial infarction within 30 days of surgery. RESULTS:<0.0001). An ECCB ≥3 was associated with 2-fold higher adjusted odds of MCE versus an ECCB <3 (adjusted odds ratio, 2.11 [95% CI, 1.42-3.12]). CONCLUSIONS:Prevalence and severity of coronary calcium obtained from existing nongated chest CT imaging improve preoperative clinical risk stratification before noncardiac surgery.
PMID: 37732454
ISSN: 1524-4539
CID: 5599072

Left Atrial Appendage Tilt-Up-and-Turn-Left Maneuver: A Novel Three-Dimensional Transesophageal Echocardiography Imaging Maneuver to Characterize the Left Atrial Appendage and to Improve Transcatheter Closure Guidance [Case Report]

Hayes, Dena E; Bamira, Daniel; Vainrib, Alan F; Freedberg, Robin S; Aizer, Anthony; Chinitz, Larry A; Saric, Muhamed
• Precise LAA anatomy must be established for LAA occlusion device selection. • We have developed the TUPLE maneuver, an acronym for “tilt up and turn left”. • The TUPLE maneuver facilitates LAA device selection and intraprocedural guidance.
PMID: 37970485
ISSN: 2468-6441
CID: 5610832

Mitral Valve-in-Ring Leaflet Thrombosis: A Multimodality Imaging Primer [Case Report]

Hayes, Dena E; Bamira, Daniel; Vainrib, Alan F; Staniloae, Cezar; Jilaihawi, Hasan; Williams, Mathew; Saric, Muhamed
PMID: 36172479
ISSN: 2468-6441
CID: 5334432

A Novel Index of Coronary Artery Calcium Derived From Preoperative Non-Gated Chest Computed Tomography Correlates With Traditional Estimates of Perioperative Risk [Meeting Abstract]

Maidman, Samuel D.; Choi, Daniel; Hayes, Dena; Dhaduk, Nehal; Donnino, Robert; Smilowitz, Nathaniel R.
ISSN: 0009-7322
CID: 5522552

Correlations Between Coronary Artery Calcium From Non-Gated Computed Tomography and Conventional Estimates of Peri-Operative Risk by Age and Sex [Meeting Abstract]

Hayes, Dena; Choi, Daniel; Maidman, Samuel D.; Dhaduk, Nehal; Donnino, Robert; Smilowitz, Nathaniel R.
ISSN: 0009-7322
CID: 5522562

Inter-Reader Reliability of Coronary Calcium Estimation From Non-Gated Chest Computed Tomography Scans Using a Semi-Quantitative Scoring Method [Meeting Abstract]

Dhaduk, Nehal; Choi, Daniel; Maidman, Samuel; Hayes, Dena; Smilowitz, Nathaniel; Donnino, Robert
ISSN: 0009-7322
CID: 5522572

Two cases of acute endocarditis misdiagnosed as COVID-19 infection

Hayes, Dena E; Rhee, David W; Hisamoto, Kazuhiro; Smith, Deane; Ro, Richard; Vainrib, Alan F; Bamira, Daniel; Zhou, Fang; Saric, Muhamed
The COVID-19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID-19 infection from other diseases. COVID-19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life-threatening acute endocarditis was initially misdiagnosed as COVID-19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
PMID: 33715241
ISSN: 1540-8175
CID: 4817282


Francke, Michael; Koutroumpakis, Efstratios; Hayes, Dena; Xiao, Emily; Zhang, Robert; Ibrahim, Tarek; Torosoff, Mikhail
ISSN: 0735-1097
CID: 5522542

Cardiovascular Disease Risk Among Young Urban Women

Giardina, Elsa-Grace V; Paul, Tracy K; Hayes, Dena; Sciacca, Robert R
BACKGROUND:Although young women are presumed to have low cardiovascular disease (CVD) risk and mortality, the mortality benefits secondary to ischemic heart disease have plateaued among young women, <50 years. MATERIALS AND METHODS:Women, 18-49 years (n = 595) among all participants (n = 1,045) in the Columbia University Heart Health in Action Study, were assessed for CVD risk burden, that is, presence of hypertension, diabetes mellitus, current tobacco use, hyperlipidemia, physical inactivity, and/or obesity. Anthropometrics (height, weight, waist circumference, and body mass index [BMI]); demographics; socioeconomic status, CVD risk factors, body size perception; knowledge and awareness of CV disease; and attitudes toward lifestyle perception were determined. RESULTS:, 29.1%; 172/592); normal weight (18.5-24.9, 41.7%; 247/592); and underweight (≤18.4; 2.2%; 13/592). More than half (57.9%; 337/582) had CVD risks: 45.9% (267/582) had >1 CVD risk factor exclusive of obesity, including physical inactivity (18.4%), hypertension (17.2%), hyperlipidemia (11.3%), current tobacco use (9.8%), and diabetes (5.6%). Regardless of CVD risk burden, most knew blood pressure, blood sugar, and cholesterol. Women with increased CVD risk burden, however, were less likely to correctly identify body size (53.3% vs. 66.1%, p = 0.002). Obese and overweight women with CVD risk factors exclusive of obesity were more likely to cite cost (23.4% vs. 10.7%, p = 0.003) and fatigue (32.2% vs. 18.8%, p = 0.006) as barriers to weight loss. CONCLUSION:Among these young women, the majority had CVD risks and the CVD risk burden is high among young women, particularly among the overweight and obese and physically inactive. Strategies to encourage healthy lifestyles and reduce CVD risk factors among this vulnerable at-risk population are vital.
PMID: 27058670
ISSN: 1931-843x
CID: 5522532