Integrated Imaging in Hypertrophic Cardiomyopathy Choudhury, Lubna, MD; Rigolin, Vera H., MD; Bonow, Robert O., MD, MS
The American journal of cardiology,
01/2017, Letnik:
119, Številka:
2
Journal Article
Recenzirano
Abstract Hypertrophic cardiomyopathy (HC) has a very heterogeneous clinical spectrum and lends itself to multimodality imaging for evaluation and management. This review addresses clinical ...applications of cardiac imaging in patients with HC. Integrating various modalities of echocardiography and cardiac magnetic resonance (CMR) are discussed in the clinical context such as diagnosis, evaluation, management, risk stratification and family screening of HC patients. The utility of peri-procedure imaging techniques are highlighted for guiding surgical and transcatheter septal reduction procedures. More limited roles of invasive or computed tomography (CT) coronary angiography are discussed for HC patients with chest pain and risk factors for coronary artery disease. Nuclear techniques though available for decades, play a more limited role in contemporary routine management, but may assist in risk assessment. Newer CMR and echo imaging techniques are discussed in their emerging roles for further characterization of HC patients and family members with prospects of preclinical diagnosis. The strengths of the different imaging modalities are presented as well as a flow diagram summarizing integrated imaging in this disease. In conclusion, integrated imaging using the various imaging modalities predominantly echocardiography and CMR based on the clinical picture, plays an essential role in the management of HC patients.
Asymptomatic Aortic Stenosis Bonow, Robert O., MD, MS
Journal of the American College of Cardiology,
12/2015, Letnik:
66, Številka:
25
Journal Article
Recenzirano
Odprti dostop
Interpreting these retrospective studies is difficult because many of the deaths occurred in individuals who had become symptomatic and it is unclear how carefully seemingly asymptomatic patients ...were followed. ...interpreting the lack of symptoms remains notoriously difficult in a population that is becoming increasing older and deconditioned; it is also well-known that patients downregulate their activity level to avert symptoms. There are also traditional customs in some Far Eastern cultures that may have led to certain patients declining surgery, even if it was recommended. ...the observations of Taniguchi et al.
Objective Bicuspid aortic valve (BAV) disease is associated with aortic dilatation and aneurysm (AN) formation. The American College of Cardiology/American Heart Association (ACC/AHA) 2006 guidelines ...recommend replacement of the ascending aorta for an aortic diameter (AD) > 45 mm in patients undergoing aortic valve replacement (AVR). We evaluated the outcomes of AVR and AVR with aortic replacement (AVR/AN). Methods We retrospectively reviewed (2004-2011) the data from 456 patients with BAV and compared the morbidity and mortality between the AVR and AVR/AN groups and 3 subgroups: AVR with an AD < 45 mm; AVR/AN with an AD of 45 to 49 mm; and AVR/AN with an AD of ≥50 mm. Propensity score matching was used to reduce bias. Results Of the 456 patients, 250 (55%) underwent AVR and 206 (45%) AVR/AN, with 98% compliance with the current guidelines. The overall 30-day mortality was 0.9%. The AVR AD < 45-mm group had adjusted short- and medium-term survival similar to that of the AVR/AN AD 45- to 49-mm and AVR/AN AD ≥ 50-mm groups, with a 30-day mortality of 0.8%, 0%, and 1.9%, respectively ( P = .41). The propensity score-matched AVR/AN AD ≥ 50-mm group had significantly greater rates of reintubation than either the AVR AD < 45-mm ( P = .012) or AVR/AN AD 45- to 49-mm ( P = .04) group and greater rates of prolonged ventilation ( P = .022) than the AVR AD < 45-mm group. No significant differences were found in reoperation or myocardial infarction among the subgroups. Conclusions In patients with undergoing AVR, no increase was seen in morbidity or mortality when adding aortic replacement with an AD of 45 to 49 mm, in accordance with the 2006 ACC/AHA guidelines, although the AVR/AN AD ≥ 50-mm group had a greater risk of respiratory complications. Our findings indicate that compliance with the ACC/AHA guidelines is safe in select centers.
In 1995, recommendations for training in adult cardiovascular medicine were published in the Journal of the American College of Cardiology as a consensus statement emanating from the Core Cardiology ...Training Symposium (COCATS) held at Heart House in Bethesda, Maryland, in June 1994 (1). Since publication of that consensus statement, the term "COCATS" has been used when referring to the American College of Cardiology (ACC) training recommendations for fellowship programs. ...the training recommendations have been revised in the current 2007 COCATS 3 report.
There are well-documented changes in thyroid hormone metabolism that accompany heart failure (HF). However, the frequency of thyroid hormone abnormalities in HF with preserved ejection fraction ...(HFpEF) is unknown, and no studies have investigated the association between triiodothyronine (T3 ) and markers of HF severity (B-type natriuretic peptide BNP and diastolic dysfunction DD) in HFpEF. In this study, 89 consecutive patients with HFpEF, defined as symptomatic HF with a left ventricular ejection fraction >50% and a left ventricular end-diastolic volume index <97 ml/m2 , were prospectively studied. Patients were dichotomized into 2 groups on the basis of median T3 levels, and clinical, laboratory, and echocardiographic data were compared between groups. Univariate and multivariate linear regression analyses were performed to determine whether BNP and DD were independently associated with T3 level. We found that 22% of patients with HFpEF had reduced T3 . Patients with lower T3 levels were older, were more symptomatic, more frequently had hyperlipidemia and diabetes, and had higher BNP levels. Severe (grade 3) DD, higher mitral E velocity, shorter deceleration time, and higher pulse pressure/stroke volume ratio were all associated with lower T3 levels. T3 was inversely associated with log BNP (p = 0.004) and the severity of DD (p = 0.039). On multivariate analysis, T3 was independently associated with log BNP (β = −4.7 ng/dl, 95% confidence interval −9.0 to −0.41 ng/dl, p = 0.032) and severe DD (β = −16.3 ng/dl, 95% confidence interval −30.1 to −2.5 ng/dl, p = 0.022). In conclusion, T3 is inversely associated with markers of HFpEF severity (BNP and DD). Whether reduced T3 contributes to or is a consequence of increased severity of HFpEF remains to be determined.
In the absence of large-scale multicenter clinical trials, there are nuances in many recommendations between the recent guidelines of the American College of Cardiology/American Heart Association and ...those of the European Society of Cardiology 4,5 that reflect differences in practice patterns in North America and Europe as well as differences in the degree of consensus among members of the respective writing committees.
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