Faculty Bibliography
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63
Reply [Letter]
PMID: 26708688
ISSN: 1879-1913
CID: 2042162
Extrinsic Esophageal Compression by Cervical Osteophytes in Diffuse Idiopathic Skeletal Hyperostosis: A Contraindication to Transesophageal Echocardiography?
Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.
PMID: 26603685
ISSN: 1540-8175
CID: 1856922
Pulmonary Vascular Congestion: A Mechanism for Distal Lung Unit Dysfunction in Obesity
RATIONALE: Obesity is characterized by increased systemic and pulmonary blood volumes (pulmonary vascular congestion). Concomitant abnormal alveolar membrane diffusion suggests subclinical interstitial edema. In this setting, functional abnormalities should encompass the entire distal lung including the airways. OBJECTIVES: We hypothesize that in obesity: 1) pulmonary vascular congestion will affect the distal lung unit with concordant alveolar membrane and distal airway abnormalities; and 2) the degree of pulmonary congestion and membrane dysfunction will relate to the cardiac response. METHODS: 54 non-smoking obese subjects underwent spirometry, impulse oscillometry (IOS), diffusion capacity (DLCO) with partition into membrane diffusion (DM) and capillary blood volume (VC), and cardiac MRI (n = 24). Alveolar-capillary membrane efficiency was assessed by calculation of DM/VC. MEASUREMENTS AND MAIN RESULTS: Mean age was 45+/-12 years; mean BMI was 44.8+/-7 kg/m2. Vital capacity was 88+/-13% predicted with reduction in functional residual capacity (58+/-12% predicted). Despite normal DLCO (98+/-18% predicted), VC was elevated (135+/-31% predicted) while DM averaged 94+/-22% predicted. DM/VC varied from 0.4 to 1.4 with high values reflecting recruitment of alveolar membrane and low values indicating alveolar membrane dysfunction. The most abnormal IOS (R5 and X5) occurred in subjects with lowest DM/VC (r2 = 0.31, p<0.001; r2 = 0.34, p<0.001). Cardiac output and index (cardiac output / body surface area) were directly related to DM/VC (r2 = 0.41, p<0.001; r2 = 0.19, p = 0.03). Subjects with lower DM/VC demonstrated a cardiac output that remained in the normal range despite presence of obesity. CONCLUSIONS: Global dysfunction of the distal lung (alveolar membrane and distal airway) is associated with pulmonary vascular congestion and failure to achieve the high output state of obesity. Pulmonary vascular congestion and consequent fluid transudation and/or alterations in the structure of the alveolar capillary membrane may be considered often unrecognized causes of airway dysfunction in obesity.
PMCID:4817979
PMID: 27035663
ISSN: 1932-6203
CID: 2059382
Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Evaluation of Newly Diagnosed Heart Failure With Reduced Left Ventricular Ejection Fraction
The aim of this study was to determine the diagnostic value of cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus nonischemic (NIC) cardiomyopathy in new-onset heart failure with reduced (
PMCID:4567940
PMID: 26251006
ISSN: 1879-1913
CID: 1709282
Congenital Absence of the Left Atrial Appendage Visualized by 3D Echocardiography in Two Adult Patients
Congenital absence of left atrial appendage (LAA) is an extremely rare condition and its physiological consequences are unknown. We present two cases of incidental finding of a congenitally absent LAA in a 79-year-old male who presented for routine transesophageal echocardiogram (TEE) to rule out intracardiac thrombus prior to placement of biventricular implantable cardioverter-defibrillator and a 54-year old female who presented for TEE prior to radiofrequency ablation of atrial fibrillation. Characterization of patients with such an absence is important because congenitally absent LAA may be confused with flush thrombotic occlusion of the appendage. There are very few published reports of congenital absence of LAA. To our knowledge, our report is the first to demonstrate the congenital absence of LAA by 3D transesophageal echocardiography.
PMID: 25586693
ISSN: 0742-2822
CID: 1436272
Coronary artery disease and the obesity paradox: A pilot study to evaluate the role of myocardial scar [Meeting Abstract]
Background: Studies show that overweight and mildly obese patients with coronary artery disease (CAD) have a better prognosis when compared to their normal weight counterparts, a phenomenon known as the obesity paradox. We investigated the possibility that this paradox might be explained by the amount of scar formed in the myocardium of obese patients following infarction. Methods: Cardiac magnetic resonance imaging (CMR) databases from 3 affiliated institutions were used to identify subjects with severe coronary disease (>70% stenosis in >1 major coronary artery or >50% stenosis of the left main) on coronary angiography and/or ischemic scar on CMR. Subjects were excluded if they had severe valvular disease, prior cardiac surgery, myocardial infarction (MI) within 1 week of CMR, or nonischemic scar on CMR. Baseline clinical variables including gender, body mass index (BMI), and risk factors for CAD were recorded. Using the 17-segment model of the left ventricle (LV), the following CMR variables were included: spatial extent (total number of segments containing any scar), transmurality (extent of transmural scar), and total scar burden (mean transmural extent of scar per segment). Pearson's correlation was used to assess the association between BMI and these CMR measurements of scar. Results: 362 subjects (21% women, mean age 62 +/- 11, mean BMI 28 +/- 5) met inclusion criteria. 68% of the subjects were overweight or obese (BMI > 25 and > 30, respectively). There was a modest but statistically significant inverse correlation between BMI and spatial extent (p = 0.049; r = -0.103) and an inverse correlation between BMI and transmurality in women (p = 0.033; r = -0.246). Conclusion: In overweight and obese patients with CAD, less LV scar may contribute to improved outcomes compared to those with normal weight. Further studies are needed to confirm these findings and elucidate potential mechanisms and possible interactions with gender
EMBASE:71834710
ISSN: 0735-1097
CID: 1561062
Effect of Computed Tomography Imaging on Rhythm Devices in Real-World Practice [Letter]
PMID: 25456766
ISSN: 0735-1097
CID: 1418902
Lone Aortic Insufficiency and Conduction Disease: A Marker of Reactive Arthritis
A 48-year-old male with history of chronic arthritis and uveitis presented with 1 year of progressively reduced exercise capacity and nonexertional chest pain. Physical examination was consistent with severe aortic insufficiency. An electrocardiogram demonstrated sinus rhythm with first degree atrioventricular block. Transthoracic and transesophageal echocardiography demonstrated severe lone central aortic insufficiency of a trileaflet valve due to leaflet thickening, retraction of leaflet margins and mild aortic root dilation in the setting of left ventricular dilatation. In addition, computed tomographic angiography revealed a small focal aneurysm of the distal transverse arch. He was found to be positive for the immunogenetic marker HLA-B27. The patient subsequently underwent uncomplicated mechanical aortic valve replacement. The diagnosis of HLA-B27 associated cardiac disease should be entertained in any individual with lone aortic insufficiency, especially if accompanied by conduction disease.
PMID: 25059534
ISSN: 0742-2822
CID: 1089472
Glucagon-like Peptide-1 receptor agonists for diabetes mellitus: a role in cardiovascular disease
PMID: 24891623
ISSN: 0009-7322
CID: 1032572
A novel and practical cardiovascular magnetic resonance method to quantify mitral annular excursion and recoil applied to hypertrophic cardiomyopathy
BACKGROUND: We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers. METHODS: We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac cycle. Based on AVJ displacement versus time, we calculated maximum AVJ displacement (MD) and velocity in early diastole (MVED), velocity in diastasis (VDS) and the composite index VDS/MVED. RESULTS: Patients with HCM showed significantly slower median lateral and septal AVJ recoil velocities during early diastole, but faster velocities in diastasis. We observed a 16-fold difference in VDS/MVED at the lateral AVJ [median 0.141, interquartile range (IQR) 0.073, 0.166 versus 0.009 IQR -0.006, 0.037, P < 0.001]. Patients with HCM also demonstrated significantly less mitral annular excursion at both the septal and lateral AVJ. Performed offline, AVJ motion analysis took approximately 10 minutes per subject. CONCLUSIONS: Atrioventricular junction motion analysis provides a practical and novel CMR method to assess mitral annular motion. In this proof of concept study we found highly statistically significant differences in mitral annular excursion and recoil between HCM patients and healthy volunteers.
PMCID:4041905
PMID: 24886666
ISSN: 1097-6647
CID: 1030702
