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Multimodality Imaging of Myocardial Viability

Parikh, Kinjan; Choy-Shan, Alana; Ghesani, Munir; Donnino, Robert
PURPOSE OF REVIEW/OBJECTIVE:Myocardial viability is an important pathophysiologic concept which may have significant clinical impact in patients with left ventricular dysfunction due to ischemic heart disease. Understanding the imaging modalities used to assess viability, and the clinical implication of their findings, is critical for clinical decision-making in this population. RECENT FINDINGS/RESULTS:The ability of dobutamine echocardiography, single-photon emission computed tomography, positron emission tomography, and cardiac magnetic resonance imaging to predict functional recovery following revascularization is well-established. Despite different advantages and disadvantages for each imaging modality, each modality has demonstrated reasonable performance characteristics in identifying viable myocardium. Recent data, however, has called into question whether this functional recovery leads to improved clinical outcomes. Although the assessment of viability can be used to aid in clinical decision-making prior to revascularization, its broad application to all patients is limited by a lack of data confirming improvement in clinical outcomes. Thus, viability assessments may be best applied to select patients (such as those with increased surgical risk) and integrated with clinical, laboratory, and imaging data to guide clinical care. Future research efforts should be aimed at establishing the impact of viability on clinical outcomes.
PMID: 33398512
ISSN: 1534-3170
CID: 4759312

Prevalence and Risk Factors of Incomplete Surgical Closure of the Left Atrial Appendage on Follow-up Transesophageal Echocardiogram

Lin, Billy; D Jaros, Brian; A Grossi, Eugene; Saric, Muhamed; S Garshick, Michael; Donnino, Robert
Objectives/UNASSIGNED:In patients with atrial fibrillation, incomplete left atrial appendage (LAA) closure is associated with an increased risk for cardio-embolic events compared to complete closure. In this study, we aimed to determine the prevalence and risk factors for incomplete surgical closure of the LAA in the modern surgical era. Methods/UNASSIGNED:Records of 74 patients with surgical LAA closure who underwent follow-up transesophageal echocardiogram for any reason between 2010 and 2016, were assessed for incomplete closure. Complete closure was defined by absence of Doppler or color flow between the left atrial appendage and the left atrial body in more than 2 orthogonal views. Results/UNASSIGNED:Surgical LAA closure was incomplete in 21 patients (28%) and complete in 53 patients (72%). All included cases were completed via oversewing method with a double layer of running suture with or without excision of the LAA. While no individual demographic, echocardiographic, or surgical feature was significantly different between groups, incomplete closure of the LAA was more prevalent in patients with two or more of the risk factors; female sex, hypertension, and hyperlipidemia (OR 5.1, 95%Cl 1.5-17). Conclusions/UNASSIGNED:A significant rate of incomplete surgical LAA closure still exists in the modern surgical era, and the presence of multiple risk factors associate an increased risk of incomplete closure.
PMID: 34950308
ISSN: 1941-6911
CID: 5110792

Gout and Progression of Aortic Stenosis

Adelsheimer, Andrew; Shah, Binita; Choy-Shan, Alana; Tenner, Craig T; Lorin, Jeffrey D; Smilowitz, Nathaniel R; Pike, V Courtney; Pillinger, Michael H; Donnino, Robert
BACKGROUND:Patients with aortic stenosis are nearly twice as likely to have a diagnosis of gout compared with individuals without aortic valve disease. METHODS:, and/or decrease in left ventricular ejection fraction due to aortic stenosis. RESULTS:/year [-0.16, -0.01], p=0.09); annualized change in peak velocity and mean gradient did not differ between groups. CONCLUSIONS:Progression to severe aortic stenosis was more frequent in patients with gout versus those without gout supporting the hypothesis that gout is a risk factor for aortic stenosis.
PMID: 32081657
ISSN: 1555-7162
CID: 4312662

A case of nonvalvular endocarditis with biventricular apical infected thrombi [Case Report]

Vani, Anish; Ahluwalia, Monica; Donnino, Robert; Jung, Albert; Vaynblat, Mikhail; Latson, Larry; Saric, Muhamed
We report what appears to be the first case of biopsy-proven nonvalvular endocarditis with biventricular apical infected thrombi. A 47-year-old man presented with hypoxic respiratory failure from a multilobar pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Transthoracic echocardiography and cardiac magnetic resonance imaging revealed biventricular apical masses suggestive of nonvalvular endocarditis with infected thrombi. Given concern for ongoing septic embolization to the lungs and brain despite appropriate antimicrobial therapy, the masses were surgically resected. Culture and histopathology confirmed MRSA-positive infected thrombi. In this case report, we highlight the differential diagnosis of apical masses and the role of multimodality imaging.
PMID: 32654168
ISSN: 1540-8175
CID: 4527722

A Rare Case of Sarcoidosis-Induced Polyserositis and Steroid-Induced Mediastinal Lipomatosis Masquerading as an Epicardial Tumor [Case Report]

Qiu, Jessica K; Dwivedi, Aeshita; Alter, Eric; Halpern, Dan; Katz, Edward S; Donnino, Robert; Saric, Muhamed
PMID: 32577599
ISSN: 2468-6441
CID: 4493172

Predicting adults likely to develop heart failure using readily available clinical information

Bergsten, Tova M; Donnino, Robert; Wang, Binhuan; Nicholson, Andrew; Fang, Yixin; Natarajan, Sundar
BACKGROUND:Heart failure is a heavy burden to the health care system in the United States. Once heart failure develops, the quality of life and longevity are dramatically affected. It is critical to prevent it. We evaluated the predictive ability of readily available clinical information to identify those likely to develop heart failure. METHODS:We used a CART model to determine the top predictors for heart failure incidence using the NHANES Epidemiologic Follow-up Study (NHEFS). The identified predictors were hypertension, diabetes, obesity, and myocardial infarction (MI). We evaluated the relationship between these variables and incident heart failure by the product-limit method and Cox models. All analyses incorporated the complex sample design to provide population estimates. RESULTS:We analyzed data from 14,407 adults in the NHEFS. Participants with diabetes, MI, hypertension, or obesity had a higher incidence of heart failure than those without risk factors, with diabetes and MI being the most potent predictors. Individuals with multiple risk factors had a higher incidence of heart failure as well as a higher hazard ratio than those with just one risk factor. Combinations that included diabetes and MI had the highest incidence rates of heart failure per 1000 person years and the highest hazard ratios for incident heart failure. CONCLUSIONS:Having diabetes, MI, hypertension or obesity significantly increased the risk for incident heart failure, especially combinations including diabetes and MI. This suggests that individuals with these conditions, singly or in combination, should be prioritized in efforts to predict and prevent heart failure incidence.
PMID: 31678585
ISSN: 1096-0260
CID: 4190512

Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction

Shah, Binita; McDonald, Daniel; Paone, Darien; Redel-Traub, Gabriel; Jangda, Umair; Guo, Yu; Saric, Muhamed; Donnino, Robert; Staniloae, Cezar; Robin, Tonya; Benenstein, Ricardo; Vainrib, Alan; Williams, Mathew R
BACKGROUND:Transcatheter aortic valve replacement (TAVR) for low gradient (LG) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) remains an area of clinical uncertainty. METHODS:Retrospective review identified 422 patients who underwent TAVR between September 4, 2014 and July 1, 2016. Procedural indication other than severe AS (n = 22) or LVEF <50% (n = 98) were excluded. Outcomes were defined by valve academic research consortium two criteria when applicable and compared between LG (peak velocity <4.0 m/s and mean gradient <40 mmHg; n = 73) and high gradient (HG) (n = 229) groups. The LG group was further categorized as low stroke volume index (SVI) (n = 41) or normal SVI (n = 32). Median follow-up was 747 days [interquartile range 220-1013]. RESULTS: = 0.39). CONCLUSION/CONCLUSIONS:Patients with preserved LVEF undergoing TAVR for severe AS with LG, including LG with low SVI, have no significant difference in adverse outcomes when compared to patients with HG.
PMID: 30203608
ISSN: 1540-8183
CID: 3278212

Multimodality imaging of scimitar syndrome in adults: A report of four cases [Case Report]

Ngai, Calvin; Freedberg, Robin S; Latson, Larry; Argilla, Michael; Benenstein, Ricardo J; Vainrib, Alan F; Donnino, Robert; Saric, Muhamed
Partial anomalous pulmonary venous return (PAPVR) comprises a group of congenital cardiovascular anomalies associated with pulmonary venous flow directly or indirectly into the right atrium. Scimitar syndrome is a variant of PAPVR in which the right lung is drained by right pulmonary veins connected anomalously to the inferior vena cava. Surgery is the definitive treatment for scimitar syndrome. However, it is not always necessary as many patients are asymptomatic, have small left-to-right shunts, and enjoy a normal life expectancy without surgery. We report multimodality imaging in four adults with scimitar syndrome and the implications for management of this rare syndrome.
PMID: 30136740
ISSN: 1540-8175
CID: 3246482

Integrating imaging modalities for diagnosing cardiac amyloidosis

Ahluwalia, M; Reyentovich, A; Donnino, R; Phillips, L M
PMID: 29987632
ISSN: 1532-6551
CID: 3192452

3D transesophageal echocardiography and radiography of mitral valve prostheses and repairs

Jafar, Nadia; Moses, Michael J; Benenstein, Ricardo J; Vainrib, Alan F; Slater, James N; Tran, Henry A; Donnino, Robert; Williams, Mathew R; Saric, Muhamed
This paper provides a comprehensive overview of 3D transesophageal echocardiography still images and movies of mechanical mitral valves, mitral bioprostheses, and mitral valve repairs. Alongside these visual descriptions, the historical overview of surgical and percutaneous mitral valve intervention is described with the special emphasis on the incremental value of 3D transesophageal echocardiography (3DTEE). For each mitral valve intervention, 2D echocardiography, chest x-ray, and fluoroscopy images corresponding to 3DTEE are given. In addition, key references on echocardiographic imaging of individual valves and procedures are enumerated in accompanying figures and tables.
PMID: 28840950
ISSN: 1540-8175
CID: 2676572