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Comparing Management Strategies in Patients With Clot-in-Transit

Zhang, Robert S; Yuriditsky, Eugene; Zhang, Peter; Elbaum, Lindsay; Bailey, Eric; Maqsood, Muhammad H; Postelnicu, Radu; Amoroso, Nancy E; Maldonado, Thomas S; Saric, Muhamed; Alviar, Carlos L; Horowitz, James M; Bangalore, Sripal
BACKGROUND/UNASSIGNED:Clot-in-transit is associated with high mortality, but optimal management strategies remain uncertain. The aim of this study was to compare the outcomes of different treatment strategies in patients with clot-in-transit. METHODS/UNASSIGNED:This is a retrospective study of patients with documented clot-in-transit in the right heart on echocardiography across 2 institutions between January 2020 and October 2023. The primary outcome was a composite of in-hospital mortality, resuscitated cardiac arrest, or hemodynamic decompensation. RESULTS/UNASSIGNED:=0.067). CONCLUSIONS/UNASSIGNED:In this study of CBT in patients with clot-in-transit, CBT or systemic thrombolysis was associated with a significantly lower rate of adverse clinical outcomes, including a lower rate of death compared with anticoagulation alone driven by the CBT group. CBT has the potential to improve outcomes. Further large-scale studies are needed to test these associations.
PMID: 38841833
ISSN: 1941-7632
CID: 5665552

Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction

Zhang, Robert S; Ro, Richard; Bamira, Daniel; Vainrib, Alan; Zhang, Lily; Nayar, Ambika C; Saric, Muhamed; Bernard, Samuel
PURPOSE OF REVIEW/OBJECTIVE:Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS/RESULTS:The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
PMID: 38526749
ISSN: 1534-3170
CID: 5644472

Anatomical/Physiological Correlates of Functional Capacity in Adults With Repaired and Nonsevere Coarctation of the Aorta

Ramachandran, Abhinay; Talmor, Nina; Saric, Muhamed; Feinberg, Jodi; Small, Adam J.; Halpern, Dan G.
Background: There is limited data regarding the interplay of anatomic and physiologic parameters with exercise capacity in adults with native or recurrent nonsevere coarctation of the aorta (CoA). Objectives: The objective of this study was to use exercise stress echocardiography and cardiac magnetic resonance imaging to identify anatomic and physiologic correlates of exercise capacity in these patients. Methods: We conducted a single-center retrospective analysis of 54 adults with nonsevere CoA (repaired or unrepaired) followed at our institution between 2015 and 2020. Resting coarctation gradients were obtained using echocardiography. Exercise gradients and functional capacity were assessed using exercise stress echocardiography. Aorta anatomy was obtained using magnetic resonance imaging. Results: Coarctation-to-diaphragm ratio correlated with minutes of exercise (r = 0.56, P < 0.01) and metabolic equivalents (r = 0.49, P < 0.01). These relationships remained significant after controlling for use of beta-blockers, valvular disease, and type of coarctation repair. Minutes of exercise correlated with mean resting gradients (r = −0.39, P < 0.05). Coarctation-to-diaphragm ratio correlated with peak and mean resting gradients (r = −0.34, P < 0.05; r = −0.48, P < 0.01). Patients with coarctation-to-diaphragm ratio ≤0.7 achieved fewer metabolic equivalents (11.1 ± 1.9 vs 12.8 ± 2.2, P < 0.05) and minutes of exercise (10.3 ± 2.0 vs 12.6 ± 2.7, P < 0.05). Conclusions: In patients with nonsevere native or recurrent CoA, reduced exercise capacity is correlated with coarctation severity by anatomic size and gradients. Those with a coarctation-to-diaphragm ratio ≤0.7 may represent a subset of patients with nonsevere CoA whose clinical symptoms are only elicited with exercise stress testing. Exercise stress testing and cross-sectional imaging may help identify those who could be considered for earlier coarctation intervention.
ISSN: 2772-963x
CID: 5621242

Quick Three-Dimensional Transesophageal Echocardiography of Left Atrial Appendage (LAA) Anatomy Using the LAA Multiview Technique

Vainrib, Alan; Saric, Muhamed
PMID: 38028389
ISSN: 2468-6441
CID: 5616882

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

Concordance of Pericardial Effusion Size Between Computed Tomography and Echocardiography

Zhang, Robert S; Alter, Eric; Kozloff, Samuel; Choy-Shan, Alana; Xia, Yuhe; Patel, Kunal; Gozansky, Elliott K; Saric, Muhamed; Stojanovska, Jadranka; Donnino, Robert
Discrepancy between computed tomography (CT) and transthoracic echocardiography (TTE) regarding pericardial effusion (PEff) size is common, but there is limited data regarding the correlation between these 2 imaging methods. The aim of this study is to examine the real-world concordance of observed PEff size between CT and TTE. We performed a retrospective analysis of all imaging reports available from 2013 to 2019 and identified patients with a PEff who underwent both a chest CT and TTE within a 24-hour period. We evaluated the agreement between CT and TTE in assessing PEff size. Of 1,118 patients included in the study, mean age was 66 (±17 years) and 54% were female. The median time interval between the 2 studies was 9.4 hours (interquartile range 3.5 to 16.6). Patients within a half-grade or full-grade of agreement were 71.9% and 97.2%, respectively. The mean difference in grade of agreement (TTE minus CT) between the 2 imaging methods was -0.1 (±0.6, p <0.0001). CT was more likely to report a higher grade (i.e. larger PEff size) when compared with TTE (261 patients vs 157 patients, p <0.001). The weighted kappa was 0.73 (95% confidence interval 0.69 to 0.76). After excluding patients with trace/no effusion, 42.3% and 94.1% of patients' studies were within a half-grade or full-grade of agreement, respectively. Of the 18 patients who had large discrepancies, 9 patients had loculated effusions, 2 patients had large pleural effusions, and 6 patients had suboptimal TTEs images. In conclusion, TTE and CT showed relatively strong agreement in estimation of PEff size, with CT sizes larger than TTE, on average. Large discrepancies in size may be related to reduced image quality, large pleural effusions, and loculated PEff.
PMID: 37487407
ISSN: 1879-1913
CID: 5606862

The Double-Orifice Left Atrial Appendage: Multimodality and Virtual Transillumination Imaging [Case Report]

Rhee, David W; Aizer, Anthony; Chinitz, Larry A; Saric, Muhamed; Vainrib, Alan F
• LAA membranes are exceedingly rare with variable morphologies. • Thromboembolic risk with LAA membranes remains unknown. • Use of 3D TEE transillumination may assist in visualization and understanding.
PMID: 37614689
ISSN: 2468-6441
CID: 5599262

The (Heart and) Soul of a Human Creation: Designing Echocardiography for the Big Data Age [Editorial]

Arnaout, Rima; Hahn, Rebecca T; Hung, Judy W; Jone, Pei-Ni; Lester, Steven J; Little, Stephen H; Mackensen, G Burkhard; Rigolin, Vera; Sachdev, Vandana; Saric, Muhamed; Sengupta, Partho P; Strom, Jordan B; Taub, Cynthia C; Thamman, Ritu; Abraham, Theodore
PMID: 37191597
ISSN: 1097-6795
CID: 5536532

Device-Associated Thrombus with Watchman FLX Left Atrial Appendage Closure Device: A Report of Two Cases [Case Report]

Dhaduk, Nehal; Vainrib, Alan F; Bamira, Daniel; Ro, Richard; Aizer, Anthony; Chinitz, Larry; Saric, Muhamed
• Individual cases of Watchman FLX DAT are scare in literature. • The Watchman FLX has shown lower rates of DAT than the Watchman 2.0. • Thrombus formation is still possible in rare instances with the Watchman FLX.
PMID: 37396475
ISSN: 2468-6441
CID: 5538982

Apical Aneurysms and Mid-Left Ventricular Obstruction in Hypertrophic Cardiomyopathy

Sherrid, Mark V; Bernard, Samuel; Tripathi, Nidhi; Patel, Yash; Modi, Vivek; Axel, Leon; Talebi, Soheila; Ghoshhajra, Brian B; Sanborn, Danita Y; Saric, Muhamed; Adlestein, Elizabeth; Alvarez, Isabel Castro; Xia, Yuhe; Swistel, Daniel G; Massera, Daniele; Fifer, Michael A; Kim, Bette
BACKGROUND:Apical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are associated with adverse outcomes. The reported frequency of mid-LV obstruction has varied from 36% to 90%. OBJECTIVES/OBJECTIVE:The authors sought to ascertain the frequency of mid-LV obstruction in HCM apical aneurysms. METHODS:The authors analyzed echocardiographic and cardiac magnetic resonance examinations of patients with aneurysms from 3 dedicated programs and compared them with 63 normal controls and 47 controls with apical-mid HCM who did not have aneurysms (22 with increased LV systolic velocities). RESULTS:]; P = 0.004). Complete emptying occurs circumferentially around central PMs that contribute to obstruction. Late gadolinium enhancement was always brightest and the most transmural apical of, or at the level of, complete emptying. CONCLUSIONS:The great majority (95%) of patients in the continuum of apical aneurysms have associated mid-LV obstruction. Further research to investigate obstruction as a contributing cause to apical aneurysms is warranted.
PMID: 36681586
ISSN: 1876-7591
CID: 5419392