Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 24
Filter
1.
Front Cardiovasc Med ; 9: 834738, 2022.
Article in English | MEDLINE | ID: mdl-35990938

ABSTRACT

Pregnancy is associated with profound hemodynamic changes that are particularly impactful in patients with underlying cardiovascular disease. Management of pregnant women with cardiovascular disease requires careful evaluation that considers the well-being of both the woman and the developing fetus. Clinical assessment begins before pregnancy and continues throughout gestation into the post-partum period and is supplemented by cardiac imaging. This review discusses the role of imaging, specifically echocardiography, cardiac MRI, and cardiac CT, in pregnant women with valvular diseases, hypertrophic cardiomyopathy, and aortic pathology.

2.
Front Cardiovasc Med ; 9: 839400, 2022.
Article in English | MEDLINE | ID: mdl-35387447

ABSTRACT

Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advancements in the field of cardiovascular imaging to aid in diagnosis, treatment, and prevention of coronary artery disease. The application of artificial intelligence in medicine, particularly in cardiovascular medicine has erupted in the past decade. This article serves to highlight the highest yield articles within cardiovascular imaging with an emphasis on coronary CT angiography methods for % stenosis evaluation and atherosclerosis quantification for the general cardiologist. The paper finally discusses the evolving paradigm of implementation of artificial intelligence in real world practice.

3.
Article in English | MEDLINE | ID: mdl-33746507

ABSTRACT

PURPOSE OF REVIEW: Social media (SoMe) as a means of knowledge dissemination has grown significantly in cardiovascular imaging in recent years. This media platform allows for a free exchange of ideas, the development of new communities, and the ability to disseminate advancements rapidly. While the social media platforms offer limitless potential, their public domain necessitates several important suggestions around best practices. RECENT FINDINGS: In cardiovascular imaging, specific hashtags have emerged to encompass the major modalities to include #EchoFirst, #YesCCT, #WhyCMR, and #CVNuc. Cardiovascular imaging journals have established major presences in the social media space as an avenue to present novel, high-quality, peer-reviewed content to new audiences. SUMMARY: This review paper aims to introduce basic concepts in social media and cardiovascular imaging while highlighting recent topics of high importance, influence, and attention in cardiovascular imaging to include the ISCHEMIA trial, COVID-19, structural imaging, and multimodality advances from throughout 2020.

4.
Womens Health Issues ; 29(5): 392-399, 2019.
Article in English | MEDLINE | ID: mdl-31350017

ABSTRACT

BACKGROUND: Our objective was to evaluate the relationship between the "Make The Call, Don't Miss a Beat" national mass media campaign and emergency medical services (EMS) use among women with possible heart attack symptoms. METHODS: We linked campaign TV public service advertisement data with national EMS activation data for 2010 to 2014. We identified EMS activations (i.e., responses) for possible heart attack symptoms and for unintentional injuries for both women and men. We estimated the impact of the campaign on the fraction of the 1.7 to 15.9 million activations of women with possible heart attack symptoms compared with 1.9 million female activations for unintentional injuries within each EMS agency and month using quasi-binomial logistic regression controlling for time and state. RESULTS: Of the 3,175 U S. counties, 90% were exposed to the campaign. However, less than 2% of U.S. counties reached moderate TV exposure (≥300 gross rating points) during the entire campaign period. We did not observe an increase in the fraction of female activations for possible heart attack during periods or in counties with higher campaign exposure. CONCLUSIONS: This mass media campaign that relied heavily on TV public service advertisements was not associated with increased EMS use by women with possible heart attack symptoms, even among counties that were more highly exposed to the campaign advertisements.


Subject(s)
Emergency Medical Services/organization & administration , Emergency Medical Services/statistics & numerical data , Health Education/organization & administration , Health Promotion/methods , Mass Media , Myocardial Infarction , Program Evaluation/methods , Adult , Advertising , Aged , Communication , Female , Health Education/methods , Humans , Logistic Models , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Television , United States
5.
Womens Health Issues ; 29(2): 116-124, 2019.
Article in English | MEDLINE | ID: mdl-30545703

ABSTRACT

BACKGROUND: We sought to determine whether gender disparities exist in the prehospital management of chest pain (CP) or out-of-hospital cardiac arrest (OHCA) among patients who accessed the emergency medical services (EMS) system. METHODS: We obtained 2010-2013 data from the National Emergency Medical Services Information System and identified all EMS activations for CP or OHCA by adults 40 years of age or older. We selected American Heart Association medications and procedures to manage cardiovascular events. We stratified women and men by age (<65 years vs. ≥65 years), race (White vs. Black), clinical condition (CP vs. OHCA), same EMS agency, and calendar year. We determined the gender-specific treatment proportions for each stratum and calculated the weighted percentage difference in treatment between women and men. RESULTS: Approximately 2.4 million CP and 284,000 OHCA activations were analyzed. Women with CP received a lower percentage of recommended treatments than men. For every 100 EMS activations by women with CP, 2.8 fewer received aspirin (95% CI, -4.8 to -0.8). The greatest gap in CP care was that women were significantly less likely to be transported using lights and sirens than men (-4.6%; 95% CI, -8.7% to -0.5%). More than 90% of OHCA activations were resuscitated; however, women were significantly less likely to be resuscitated compared with men (-1.3%; 95% CI, -2.4% to -0.2%). CONCLUSIONS: Small to modest disparities between otherwise similar women and men in the EMS treatment of CP and OHCA suggest the need for further evaluation and research with detailed contextual and outcome data.


Subject(s)
Cardiopulmonary Resuscitation/statistics & numerical data , Chest Pain/therapy , Emergency Medical Services/standards , Healthcare Disparities , Out-of-Hospital Cardiac Arrest/therapy , Women , Adult , Aged , Aged, 80 and over , Emergency Medical Services/statistics & numerical data , Female , Humans , Male , Middle Aged , Sex Factors
6.
Heart ; 104(17): 1469-1470, 2018 09.
Article in English | MEDLINE | ID: mdl-29934369

ABSTRACT

CLINICAL INTRODUCTION: A 63-year-old man with HIV presented with 1 month of dyspnoea and productive cough without orthopnoea. He was afebrile with normal blood pressure, borderline tachycardia and mild pulmonary wheezing. He had exertional hypoxia requiring 4 L per minute of oxygen. No murmurs, jugular venous distention or lower extremity oedema was noted. Clinical evaluation included transthoracic echocardiography (TTE), which showed mild left ventricular hypertrophy with normal size and systolic function. The right ventricle was normal. There was mild aortic insufficiency; other valves were normal. An abnormality was incidentally seen at the aortic root.The patient was treated for bronchitis and chronic obstructive pulmonary disease exacerbation, while further evaluation of the incidental aortic root finding was performed with transoesophageal echocardiography (TEE) and cardiac MRI (CMR). QUESTION: What is the most likely diagnosis for this finding?Sinus of Valsalva aneurysm.Chronic aortic dissection.Left ventricular outflow tract (LVOT) pseudoaneurysm.Right coronary artery aneurysm.Aortic root abscess.


Subject(s)
Aneurysm, False/diagnostic imaging , Aorta/diagnostic imaging , Aortic Valve/diagnostic imaging , Bronchitis , Echocardiography/methods , Heart Ventricles/diagnostic imaging , Magnetic Resonance Imaging, Cine/methods , Bronchitis/complications , Bronchitis/diagnosis , Bronchitis/physiopathology , HIV Infections/complications , Humans , Incidental Findings , Male , Middle Aged , Ventricular Outflow Obstruction/diagnosis , Ventricular Outflow Obstruction/etiology
7.
Clin Cardiol ; 40(9): 648-653, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28444996

ABSTRACT

Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.


Subject(s)
Breast Neoplasms/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Incidental Findings , Mammography , Vascular Calcification/diagnostic imaging , Adult , Aged , Asymptomatic Diseases , Coronary Artery Disease/epidemiology , Female , Humans , Mammography/standards , Middle Aged , Practice Guidelines as Topic , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , Severity of Illness Index , Vascular Calcification/epidemiology
8.
Cardiovasc Ultrasound ; 12: 44, 2014 Oct 31.
Article in English | MEDLINE | ID: mdl-25361851

ABSTRACT

BACKGROUND: Studies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR). We tested the hypothesis that the transit time during contrast echocardiography could accurately estimate both CO and PVR compared to right heart catheterization (RHC). METHODS: 27 patients scheduled for RHC had 2D-echocardiogram immediately prior to RHC. 3 ml of DEFINITY contrast followed by a 10 ml saline flush was injected, and a multi-cycle echo clip was acquired from the beginning of injection to opacification of the left ventricle. 2D-echo based calculations of CO and PVR along with the DEFINITY-based transit time calculations were subsequently correlated with the RHC-determined CO and PVR. RESULTS: The transit time from full opacification of the right ventricle to full opacification of the left ventricle inversely correlated with CO (r=-0.61, p<0.001). The transit time from peak opacification of the right ventricle to first appearance in the left ventricle moderately correlated with PVR (r=0.46, p<0.01). Previously described echocardiographic methods for the determination of CO (Huntsman method) and PVR (Abbas and Haddad methods) did not correlate with RHC-determined values (p = 0.20 for CO, p = 0.18 and p = 0.22 for PVR, respectively). The contrast transit time method demonstrated reliable intra- (p<0.0001) and inter-observer correlation (p<0.001). CONCLUSIONS: We describe a novel method for the quantification of CO and estimation of PVR using contrast echocardiography transit time. This technique adds to the methodologies used for noninvasive hemodynamic assessment, but requires further validation to determine overall applicability.


Subject(s)
Cardiac Output , Echocardiography/methods , Heart Ventricles/physiopathology , Models, Cardiovascular , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Vascular Stiffness , Algorithms , Cardiac Catheterization , Computer Simulation , Contrast Media , Female , Fluorocarbons , Heart Ventricles/diagnostic imaging , Humans , Image Interpretation, Computer-Assisted/methods , Male , Middle Aged , Pulse Wave Analysis , Reproducibility of Results , Sensitivity and Specificity
9.
Echocardiography ; 31(4): 442-8, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24199601

ABSTRACT

BACKGROUND: Pulmonary hypertension (PH) in patients with systemic hypertension and preserved ejection fraction (PEF) has been described. However, the pathophysiology and consequences are not entirely clear. We sought to distinguish the clinical and anatomic features among hypertensive patients with or without coexistent PH. METHODS: Echocardiograms and records of hypertensive patients with left ventricular (LV) hypertrophy and PEF from January 2009 to January 2011 were reviewed. We identified 174 patients, including 36 with PH (calculated pulmonary artery systolic pressure [PASP] ≥ 35 mmHg), and 138 with normal pulmonary pressures. RESULTS: Hypertensive patients with PH were older (76 ± 13 vs. 65 ± 13 years, P < 0.0001), more often female (91, 70%), had lower estimated glomerular filtration rate (eGFR) (63 ± 44 vs. 88 ± 48 mL/min, P = 0.002), and higher pro-BNP levels (3141 ± 4253 vs. 1219 ± 1900 pg/mL, P = 0.003). PH patients also had larger left atrial areas (23.7 ± 3.8 vs. 20.8 ± 4.6 cm(2) , P = 0.002), evidence of diastolic dysfunction (i.e., septal E/e' 17.6 ± 8.6 vs. 12.7 ± 4.4, P = 0.0005), and higher calculated peripheral vascular resistance (PVR) (2.3 ± 1.1 vs. 1.6 ± 0.4, P < 0.0001). Both PVR and septal E/e' showed strong linear correlation with PASP (P < 0.0001 and P < 0.0001, respectively). CONCLUSIONS: Hypertension in elderly patients is frequently complicated by LV diastolic dysfunction and secondary PH. These hypertensive patients tended to have reduced renal function and higher pro-BNP. Because of the known morbidity and mortality associated with PH, these observations have potentially important implications for target medical therapy.


Subject(s)
Heart Failure, Diastolic/diagnostic imaging , Hypertension, Pulmonary/diagnostic imaging , Hypertrophy, Left Ventricular/diagnostic imaging , Stroke Volume/physiology , Vascular Resistance/physiology , Age Factors , Aged , Aged, 80 and over , Cohort Studies , Echocardiography/methods , Female , Follow-Up Studies , Heart Failure, Diastolic/complications , Humans , Hypertension/complications , Hypertension/diagnosis , Hypertension/diagnostic imaging , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Linear Models , Male , Middle Aged , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Factors , Statistics, Nonparametric , Time Factors
10.
J Am Soc Echocardiogr ; 24(12): 1325-30, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21925836

ABSTRACT

BACKGROUND: Pocket-size ultrasound has increased echocardiographic portability, but expert point-of-care interpretation may not be readily available. The aim of this study was to test the hypothesis that remote interpretation on a smartphone with dedicated medical imaging software can be as accurate as on a workstation. METHODS: Eighty-nine patients in a remote Honduran village underwent echocardiography by a nonexpert using a pocket-size ultrasound device. Images were sent for verification of point-of-care diagnosis to two expert echocardiographers in the United States reading on a workstation. Studies were then anonymized, randomly ordered, and reinterpreted on a smartphone with a dedicated, Health Insurance Portability and Accountability Act-compliant application. Point-of-care diagnosis was considered accurate if any abnormal finding was matched and categorized at the same level of severity (mild, moderate, or severe) by either expert interpretation. RESULTS: The mean age was 54 ± 23 years, and 57% of patients were women. The most common indications for echocardiography were arrhythmia (33%), cardiomyopathy (28%), and syncope (15%). Using the workstation, point-of-care diagnoses were changed in 38% of cases by expert overread (41% left ventricular function correction, 38% valvulopathy correction, 18% poor image quality). Expert interobserver agreement was excellent at 82%, with a Cohen's κ value of 0.82 (95% confidence interval, 0.70-0.94). Intraobserver agreement comparing interpretations on workstations and smartphones was 90%, with a Cohen's κ value of 0.86 (95% confidence interval, 0.76-0.97), signifying excellent intertechnology agreement. CONCLUSIONS: Remote expert echocardiographic interpretation can provide backup support to point-of-care diagnosis by nonexperts when read on a dedicated smartphone-based application. Mobile-to-mobile consultation may improve access in previously inaccessible locations to accurate echocardiographic interpretation by experienced cardiologists.


Subject(s)
Cell Phone , Echocardiography/instrumentation , Echocardiography/methods , Heart Diseases/diagnostic imaging , Telemedicine/instrumentation , Telemedicine/methods , District of Columbia , Equipment Design , Equipment Failure Analysis , Female , Humans , Male , Reproducibility of Results , Sensitivity and Specificity
11.
J Cardiovasc Comput Tomogr ; 5(1): 44-9, 2011.
Article in English | MEDLINE | ID: mdl-21130724

ABSTRACT

BACKGROUND: Computed tomography coronary angiography (CTCA) provides an accurate noninvasive alternative to the invasive assessment of coronary artery disease. However, a specific limitation of CTCA is inability to assess hemodynamic data. OBJECTIVE: We hypothesized that CTCA-derived measurements of contrast within the superior vena cava (SVC) and inferior vena cava (IVC) would correlate to echocardiographic estimations of right atrial and right ventricular pressures. METHODS: Medical records of all patients who underwent both echocardiography and CTCA in our center were reviewed (n = 32). Standard CTCA was performed with a 64-detector CT using test-bolus method for image acquisition timing and iso-osmolar contrast injection through upper extremity vein. The length of the column of contrast reflux into the inferior vena cava (IVC) was correlated to echocardiographically determine tricuspid regurgitation jet velocity (TRV). SVC area change with contrast injection at the level of the bifurcation of the pulmonary artery was also correlated with IVC sniff response by echocardiogram. RESULTS: The reflux column length was interpretable in 27 of 32 patients with a mean length of 10.1 ± 1.1 mm, and a significant bivariate correlation was observed between reflux column length and the tricuspid regurgitant jet velocity (r = 0.84; P < .0001). Mean SVC distensibility ratio was 0.63 ± 0.03; mean IVC sniff response ratio was 0.53 ± 0.03. SVC distensibility correlated to IVC sniff response with a Pearson r of 0.57 (P = .04). CONCLUSION: Quantification of IVC and SVC contrast characteristics during CTCA provides a feasible and potentially accurate method of estimating right atrial and ventricular pressure.


Subject(s)
Blood Pressure Determination/methods , Coronary Angiography/methods , Heart Atria/physiopathology , Radiographic Image Interpretation, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/physiopathology , Algorithms , Atrial Function, Right , Blood Pressure , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity
12.
Clin Cardiol ; 31(12): 597-601, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19072883

ABSTRACT

BACKGROUND: Normal left ventricular (LV) systolic function is present in as many as 50% of patients with congestive heart failure. The majority of such patients have systemic hypertension. Recent studies have demonstrated LV dyssynchrony among patients with heart failure and normal systolic function. However, it is unclear whether such abnormalities exist in hypertensive patients who have not developed clinical evidence of heart failure. METHODS: Hospitalized patients with established hypertension undergoing echocardiography who met the following criteria were eligible for the study: LV ejection fraction (EF) >or= 50%, wall >or=11 mm, absence of valvular or known ischemic disease, and normal QRS duration. Complete 2-Dimensional and Doppler echocardiography studies with tissue Doppler imaging (TDI) were performed in all patients. Dyssynchrony was measured using time from QRS to peak systolic velocity on TDI (T-P) in 3 apical views. Normal values for dyssynchrony were established in a group of normotensive patients with normal echocardiography studies. RESULTS: The study included 42 patients (19 women, 23 men with a, mean age of 59.6 y (range 32-96 y). Left ventricular dyssynchrony was common, occurring in 20 of 42 patients (47.6%). Dyssynchrony assessed with the maximum T-P (T-Pmax) was significantly related to LV mass (r = 0.32, p = 0.036), left atrial volume (r = 0.59, p < 0.0001), and LV sphericity index (0.32, p = 0.037). Dyssynchrony was not related to age or LV filling pressure calculated from the Doppler study. CONCLUSIONS: Left ventricular dyssynchrony is common among hypertensive patients with normal LV systolic function and no evidence of congestive heart failure. The severity of LV dyssynchrony is related to the magnitude of LV hypertrophy, left atrial size, and LV remodeling.


Subject(s)
Hypertension/epidemiology , Hypertension/physiopathology , Ventricular Dysfunction, Left/epidemiology , Adult , Aged , Aged, 80 and over , Comorbidity , Echocardiography, Doppler , Female , Heart Atria/pathology , Heart Failure/epidemiology , Humans , Hypertrophy, Left Ventricular/epidemiology , Male , Middle Aged , Systole/physiology , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Remodeling/physiology
13.
Am Heart J ; 149(3): 527-33, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15864243

ABSTRACT

BACKGROUND: Exercise testing, a major diagnostic modality in individuals with suspected coronary artery disease (CAD), has in general demonstrated less overall diagnostic accuracy in women compared to men. As part of the WISE, a modified protocol was examined with the intention of improving reliability of exercise testing. METHODS: Criteria for entry in the WISE study include clinically indicated coronary angiography. Exercise testing was performed using a protocol modified to be more appropriate for women. The study population consisted of 96 women, mean age of 55.8 y (range 34-77), who completed exercise treadmill test (ETT). Most (78%) were postmenopausal; 96% had >or =2 risk factors for CAD. RESULTS: By core laboratory angiography, 29/96 women had stenosis > or =50% in at least one coronary artery. Of these 29 women, 9 had abnormal ETT, yielding overall sensitivity of 31%. The remaining 20 women had normal (12/29, 41%) or nondiagnostic (8/29, 28%) studies. Among the 67 women with minimal or no coronary stenosis, 35 had no ischemic ST-segment changes during ETT, yielding overall specificity of 52%. Analysis with exclusion of women with nondiagnostic studies yielded sensitivity and specificity of 43% and 66%, respectively. The presence of coronary artery stenosis and inability to perform ETT, but not results of testing, predicted the outcomes of myocardial infarction, heart failure, and death. CONCLUSIONS: Exercise treadmill test appears to be of limited diagnostic value in women with suspected myocardial ischemia referred for coronary angiography. Sensitivity and specificity remain poor even with modified exercise protocol and core laboratory angiographic analysis. These findings merit consideration in view of current guidelines that recommend exercise testing in women with suspected CAD.


Subject(s)
Coronary Stenosis/diagnosis , Exercise Test/methods , Myocardial Ischemia/diagnosis , Women's Health , Adult , Aged , Clinical Protocols , Coronary Angiography , Coronary Stenosis/complications , Electrocardiography , Female , Follow-Up Studies , Humans , Middle Aged , Myocardial Ischemia/etiology , Sensitivity and Specificity
14.
Am J Cardiol ; 94(4): 535-8, 2004 Aug 15.
Article in English | MEDLINE | ID: mdl-15325950

ABSTRACT

This study sought to determine the influence of gender and/or race on the hemodynamic response to dobutamine during dobutamine stress echocardiography. Blood pressure response patterns differed by gender and race, and completion of testing was often limited because of adverse events, namely, hypertension. Gender and racial differences in blood pressure response merit consideration as potential contributors to the suboptimal response in dobutamine stress testing.


Subject(s)
Echocardiography, Stress/statistics & numerical data , Ethnicity/statistics & numerical data , Hemodynamics/drug effects , Adult , Aged , Aged, 80 and over , Blood Pressure/drug effects , Dobutamine/administration & dosage , Dobutamine/adverse effects , Dose-Response Relationship, Drug , Electrocardiography/drug effects , Female , Heart Failure/diagnosis , Heart Failure/physiopathology , Heart Rate/drug effects , Humans , Infusions, Intravenous , Male , Mathematical Computing , Middle Aged , Prospective Studies , Reference Values
17.
J Am Soc Echocardiogr ; 16(10): 1085-7, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14566306

ABSTRACT

We report a case of posttraumatic left ventricular outflow tract aneurysm in a patient who had a stab injury to the chest requiring emergency operation 40 years previously. After apparent decades without symptoms, the patient presented with exertional dyspnea. Clinical and echocardiographic assessment revealed aortic regurgitation and left ventricular outflow tract aneurysm. Injuries to the chest wall that penetrate the heart and great vessels are life-threatening and require emergency operative intervention. However, these injuries rarely, as in this case, result in chronic cardiac aneurysm and aortic valvular incompetence.


Subject(s)
Aortic Aneurysm, Thoracic/diagnostic imaging , Heart Injuries/diagnostic imaging , Ventricular Outflow Obstruction/diagnostic imaging , Wounds, Stab/diagnostic imaging , Aortic Aneurysm, Thoracic/etiology , Diagnosis, Differential , Echocardiography , Echocardiography, Transesophageal , Heart Injuries/complications , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Ventricular Outflow Obstruction/etiology , Wounds, Stab/complications
18.
Curr Opin Cardiol ; 18(5): 334-9, 2003 Sep.
Article in English | MEDLINE | ID: mdl-12960463

ABSTRACT

The diagnosis of mitral regurgitation is often made from physical diagnosis, but quantitation of severity of valvular dysfunction and timing of intervention are often quite challenging. The purpose of this review is to examine the recent echocardiographic methods reported for quantitative assessment of mitral regurgitation, and the role of echocardiography in guiding medical and surgical management. Refinement of quantitative methods and development of newer technologies, including three-dimensional echocardiography, provide more accurate assessment of mitral anatomy and function. These methods for evaluation of the mitral valve to ascertain etiology or mechanism have important implications for medical or surgical management. This review summarizes the recent literature addressing the role of echocardiography in the diagnosis, management and prognosis of mitral regurgitation.


Subject(s)
Echocardiography/methods , Mitral Valve Insufficiency/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Echocardiography, Transesophageal/methods , Humans , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/surgery , Preoperative Care , Prognosis
20.
J Am Coll Cardiol ; 41(6): 974-80, 2003 Mar 19.
Article in English | MEDLINE | ID: mdl-12651044

ABSTRACT

OBJECTIVES: The goal of this study was to determine the impact of race on identification of hypertrophic cardiomyopathy (HCM). BACKGROUND: Sudden death in young competitive athletes is due to a variety of cardiovascular diseases (CVDs) and, most commonly, HCM. These catastrophes have become an important issue for African Americans, although HCM has been previously regarded as rare in this segment of the U.S. population. METHODS: We studied the relationship of race to the prevalence of CVDs causing sudden death in our national athlete registry, and compared these findings with a representative multicenter hospital-based cohort of patients with HCM. RESULTS: Of 584 athlete deaths, 286 were documented to be due to CVD at ages 17 +/- 3 years; 156 (55%) were white, and 120 (42%) were African American. Most were male (90%), and 67% participated in basketball and football. Among the 286 cardiovascular deaths, most were due to HCM (n = 102; 36%) or anomalous coronary artery of wrong sinus origin (n = 37; 13%). Of the athletes who died of HCM, 42 (41%) were white, but 56 (55%) were African American. In contrast, of 1,986 clinically identified HCM patients, only 158 (8%) were African American (p < 0.001). CONCLUSIONS: In this autopsy series, HCM represented a common cause of sudden death in young and previously undiagnosed African American male athletes, in sharp contrast with the infrequent clinical identification of HCM in a hospital-based population (i.e., by seven-fold). This discrepancy suggests that many HCM cases go unrecognized in the African American community, underscoring the need for enhanced clinical recognition of HCM to create the opportunity for preventive measures to be employed in high-risk patients with this complex disease.


Subject(s)
Black or African American/statistics & numerical data , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/ethnology , Death, Sudden, Cardiac/ethnology , Death, Sudden, Cardiac/etiology , Ethnicity/statistics & numerical data , Registries/statistics & numerical data , Sports/statistics & numerical data , Adolescent , Adult , Cardiomyopathy, Hypertrophic/mortality , Child , Death, Sudden, Cardiac/epidemiology , Female , Humans , Male , Retrospective Studies , Risk Factors , Sex Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...