Timing of Statin Dose: A Systematic Review and Meta-analysis of Randomized Clinical Trials
Aortic closure signal length on doppler echocardiography differentiates aortic patient-prosthesis mismatch from prosthetic stenosis
PURPOSE/OBJECTIVE:The purpose of this study was to investigate the diagnostic potential of the aortic closure (A2) signal length on Doppler echocardiography in distinguishing aortic patient-prosthesis mismatch (PPM) from prosthetic stenosis among patients with elevated gradients over bioprosthetic valves. METHODS:The A2 signal length was retrospectively measured for 150 patients with bioprosthetic aortic valves (50 with PPM, 50 with prosthetic stenosis, and 50 with normally functioning valves) from transthoracic echocardiograms performed at NYU Langone Health between 01/01/2012 and 08/01/2018. RESULTS:Mean A2 signal length was shorter among patients with PPM (11.1 msâ€‰Â±â€‰5.2 ms), than among those with prosthetic stenosis (21.1 msâ€‰Â±â€‰6.0 ms), Pâ€‰<â€‰.001 and controls (21.7 msâ€‰Â±â€‰7.4 ms), Pâ€‰<â€‰.001. There was no difference in A2 signal length between prosthetic stenosis and controls. The A2 signal length yielded an AUC of 0.89 (95% CI 0.82-0.95) for predicting PPM over prosthetic stenosis. CONCLUSION/CONCLUSIONS:Among patients with bioprosthetic aortic valves, the length of the A2 signal on Doppler echocardiography is shorter in PPM than in prosthetic stenosis and normally functioning valves. The A2 signal length may represent a novel metric to distinguish PPM from prosthetic stenosis.
S2 LENGTH ON DOPPLER ECHOCARDIOGRAPHY DIFFERENTIATES AORTIC PATIENT PROSTHESIS MISMATCH VERSUS PROSTHETIC STENOSIS [Meeting Abstract]
PERSISTENT ALCAPA PHYSIOLOGY AFTER ALCAPA REPAIR [Meeting Abstract]
Average e' velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation
BACKGROUND:Studies have demonstrated the value of transthoracic echocardiogram (TTE) diastolic parameters in predicting left atrial appendage (LAA) thrombus; however, these studies have been small. We aim to clarify the relationship between TTE diastolic parameters, in particular average e', and LAA thrombus or sludge. METHODS:A case-control review was conducted of subjects with non-valvular atrial fibrillation (n = 2263) who had undergone TEE (transesophageal echocardiogram) and had a TTE within 1 year of TEE. Cases of LAA sludge or thrombus were matched to controls by age, sex, left ventricular ejection fraction (LVEF), and anticoagulation status. RESULTS:Forty-three subjects (mean age 73 Â± 12, 65% male, LVEF 47%, 44% on anticoagulation) with LAA sludge or thrombus were identified. Compared to matched controls, average TTE e' (7.3 Â± 2.1 cm/s vs 8.7 Â± 2.1 cm/s, P < 0.001) and the E:e' ratio (15 Â± 7 cm/s vs 12 Â± 5 cm/s; P = 0.005) were significant predictors of LAA sludge or thrombus. Average TTE e' value of >11 cm/s had 100% sensitivity for ruling out LAA sludge or thrombus. CONCLUSION/CONCLUSIONS:In individuals with atrial fibrillation, average e' >11 cm/s on TTE is a promising independent predictor of the absence of LAA sludge or thrombus on TEE.
Improving Care Using a Bidirectional Geriatric Cardiology Consultative Conference
More than 13 million persons in the United States aged 65 and older have cardiovascular disease (CVD), and this population is expected to increase exponentially over the next several decades. In the absence of clinical studies that would inform how best to manage this population, there is an urgent need for collaborative, thoughtful approaches to their care. Although cardiologists are traditionally regarded as leaders in the care of older adults with CVD, these individuals have multiple comorbidities, physiological differences, and distinct goals of care than younger patients that require a specialized geriatric lens. Thus, collaboration is needed between geriatricians, cardiologists, and other specialists to address the unique needs of this growing population. Accordingly, clinicians at New York University Langone Health and School of Medicine established a monthly Geriatric Cardiology Conference to foster an integrative approach to the care of older adults with CVD by uniting specialists across disciplines to collaborate on treatment strategies. At each conference, an active case is discussed and analyzed in detail, and a consensus is reached among participants regarding optimal treatment strategies. The conference attracts faculty and trainees at multiple levels from geriatrics, cardiology, and cardiothoracic surgery. The model may serve as a paradigm for other institutions moving towards geriatric-informed care of older adults with CVD.
Positional Right Ventricular Obstruction in Pectus Excavatum
Pectus excavatum is one of the most common congenital chest wall deformities. The degree of sternal depression, which may result in compression of the right heart by the chest wall, is variable. While typically asymptomatic, there are various symptoms that can result from severe pectus excavatum. We report on a patient with severe pectus excavatum leading to dynamic obstruction of the right ventricular outflow tract in the seated position.
A Case of Coronary Artery Spasm Associated with Lisdexamfetamine Use
USE OF DIASTOLIC PARAMETERS ON TRANSTHORACIC ECHOCARDIOGRAM TO PREDICT LEFT ATRIAL APPENDAGE THROMBUS IN PATIENTS WITH ATRIAL FIBRILLATION [Meeting Abstract]
Impact Of A Brief, Blended Curriculum On Point-Of-Care Echocardiography For Internal Medicine Residents [Meeting Abstract]