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Introduction: Aortic pulsatility index (API), calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel hemodynamic measurement representing cardiac filling pressures and... more
Introduction: Aortic pulsatility index (API), calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel hemodynamic measurement representing cardiac filling pressures and contractility. Hypothesis: API would predict heart failure hospitalizations in acutely decompensated heart failure participants in the Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness (ESCAPE) trial. Methods: From the ESCAPE trial individual-level data API, cardiac power output (CPO), and pulmonary artery pulsatility index (PAPI) were calculated, as well as reported routine invasive hemodynamics at baseline and after final hemodynamic-monitored optimization. Outcomes assessed were need for any rehospitalization and time to any first rehospitalization. Univariable analysis was conducted to assess rehospitalization. Negative binomial regression was used to analyze duration of time from discharge to first reho...
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Introduction: Death rates from acute coronary syndrome events (ASCE) are 30% higher in African Americans than in Caucasians. A potential reason for this disparity is the underdiagnosis of ACSE due ...
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Background: It is unclear whether artificial intelligence (AI) can provide automatic solutions to measure right ventricular ejection fraction (RVEF), due to the complex RV geometry. Although several deep learning (DL) algorithms are... more
Background: It is unclear whether artificial intelligence (AI) can provide automatic solutions to measure right ventricular ejection fraction (RVEF), due to the complex RV geometry. Although several deep learning (DL) algorithms are available to quantify RVEF from cardiac magnetic resonance (CMR) images, there has been no systematic comparison of these algorithms, and the prognostic value of these automated measurements is unknown. We aimed to determine whether RVEF measurements made using DL algorithms could be used to risk stratify patients similarly to measurements made by an expert. Methods: We identified from a pre-existing registry 200 patients who underwent CMR. RVEF was determined using 3 fully automated commercial DL algorithms (DL-RVEF) and also by a clinical expert (CLIN-RVEF) using conventional methodology. Each of the DL-RVEF approaches was compared against CLIN-RVEF using linear regression and Bland-Altman analyses. In addition, RVEF values were classified according to...
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Background: Catheter ablation as first-line therapy for ventricular tachycardia (VT) at the time of implantable cardioverter defibrillator (ICD) implantation has not been adopted into clinical guidelines. Also, there is an unmet clinical... more
Background: Catheter ablation as first-line therapy for ventricular tachycardia (VT) at the time of implantable cardioverter defibrillator (ICD) implantation has not been adopted into clinical guidelines. Also, there is an unmet clinical need to prospectively examine the role of VT ablation in patients with nonischemic cardiomyopathy, an increasingly prevalent population that is referred for advanced therapies globally. Methods: We conducted an international, multicenter, randomized controlled trial enrolling 180 patients with cardiomyopathy and monomorphic VT with an indication for ICD implantation to assess the role of early, first-line ablation therapy. A total of 121 patients were randomly assigned (1:1) to ablation plus an ICD versus conventional medical therapy plus an ICD. Patients who refused ICD (n=47) were followed in a prospective registry after stand-alone ablation treatment. The primary outcome was a composite end point of VT recurrence, cardiovascular hospitalization, ...
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Additional file 1: Fig. S1. Correlation plot of HRS components and SDOH: Components of the HRS showed minimal collinearity with SDOH. Fig. S2. ROC for patients with and without admission 30 days before index: When stratified by the (a)... more
Additional file 1: Fig. S1. Correlation plot of HRS components and SDOH: Components of the HRS showed minimal collinearity with SDOH. Fig. S2. ROC for patients with and without admission 30 days before index: When stratified by the (a) presence or (b) absence of a prior admission within the prior 30 days, the addition of SDOH to the HRS did not improve its performance, similar to the unstratified dataset. Fig. S3. ROC for HRS and ADI + HRS or HRS and HI + HRS: Repeating our analysis by substituting the (a) ADI or (b) HI for the SVI produced similar results to our initial analyses; the addition of measures of SDOH did not improve the predictive performance of the HRS. Table S1. PCA Component Scores, all patients. Table S2. PCA Component Scores, randomly-sampled balanced dataset. Table S3. PCA Component Scores, patients with heart failure. Table S4. PCA Component Scores, patients with atrial fibrillation. Table S5. PCA Component Scores, patients with coronary artery disease. Table S6....
Additional file 1: sFigure 1. Imprecision (% CV) at various levels of hs-cTnT during initial verification. Three patient pools are measured on two Roche Cobas e602 analyzers once per day for 20 days (40 points per pool). 10% CV is... more
Additional file 1: sFigure 1. Imprecision (% CV) at various levels of hs-cTnT during initial verification. Three patient pools are measured on two Roche Cobas e602 analyzers once per day for 20 days (40 points per pool). 10% CV is estimated at 11 ng/L cTnT. sTable 1. The top 10 reasons for emergency department visits by number of encounters. sTable 2. Baseline demographics by race, aggregated on the patient level. For repeated encounters, only the first patient encounter was used. Categorical variables expressed as count (percent). Normally distributed continuous variables expressed as mean (standard deviation), non-normally distributed continuous variables expressed as mean [inter-quartile range]. sFigure 2. Scatter plot of BMI and high sensitivity cardiac troponin T. Negative weak correlation. sFigure 3. Scatter plot of age with only encounters where eGFR ≥ 90 mL/min/1.73 m2. sTable 3. hs-cTnT values at the 25th, 50th, 75th, and 99th percentiles stratified by sex, race, age group,...
Purpose Cardiac sarcoidosis (CS) is a chronic granulomatous disease of uncertain etiology that has the potential to recur in transplanted hearts. Practice guidelines outlining the optimal care of CS patients do not currently exist for... more
Purpose Cardiac sarcoidosis (CS) is a chronic granulomatous disease of uncertain etiology that has the potential to recur in transplanted hearts. Practice guidelines outlining the optimal care of CS patients do not currently exist for heart transplant recipients. We therefore conducted an online survey of heart transplant providers to gain insight into current practice patterns. Methods An online survey was distributed to members of the International Society for Heart and Lung Transplantation. It consisted of 16 questions designed to classify provider type, location and management preferences. Differences between groups were analyzed for significance using Chi-square and/or Fisher exact tests. Results 82 providers from 49 different transplant centers responded to our survey. Among respondents, 56 (69%) were cardiologists, 11 (13.1%) advanced practice providers, and 3 (3.6%) surgeons. A significantly greater percentage of centers maintained their CS versus non-CS patients on lifelong prednisone (58.2% vs 4.9%, p Conclusion A significantly greater proportion of CS patients are maintained on lifelong prednisone post-OHT compared to non-CS patients. For routine monitoring of CS recurrence, cardiac MRI and PET appear to be the preferred modalities for assessing CS recurrence in the allograft. However, a significant percentage of providers do not routinely monitor for CS recurrence post-OHT.
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Purpose This study aims to determine whether a patient's race or gender has any effect on the hemodynamic response to milrinone and time to LVAD or transplant. Methods Patients with systolic heart failure in an urban academic center... more
Purpose This study aims to determine whether a patient's race or gender has any effect on the hemodynamic response to milrinone and time to LVAD or transplant. Methods Patients with systolic heart failure in an urban academic center were referred for a right heart catheterization and milrinone drug study between June 2014 and November 2018. Drug studies were performed and hemodynamics, including Fick cardiac index (Fick CI) and pulmonary capillary wedge pressure (PCWP), were measured before and after infusion of milrinone at 5mcg/kg/min for 10 min. In addition, time to LVAD or transplant was recorded and results were compared by gender and race. Univariate and multivariate logistic regression were then performed and the results were analyzed retrospectively. Results A total of 237 milrinone drug studies were performed during the study period. 54% of the patients were black (n=127), 46% identified as other (white, asian, latino, arabic; n=110), 34% were women (n=80) and 66% were men (n=157). Black patients had a less robust percent decrease in PCWP than patients of other race (-0.2096 ± 0.2299 vs -0.2687 ± 0.2290, p=0.05) and black patients had a greater percent increase in Fick CI, though results did not reach significance (0.3776 [0.1667-0.5714] vs 0.3125 [0.1667-0.4444], p=0.10). Women had a less robust percent decrease in PCWP than men (-0.1721 ± 0.2264 vs -0.2687 ± 0.2270, 0.002), but women did not have a significant change in Fick CI compared to men (0.3298 [0.1579 - 0.5217] vs 0.3604 [0.1694 - 0.5188], p=0.61). Freedom from LVAD or transplant for black patients was 50% at 65 months and 30% at 52 months for other race (p=0.008). There was no significant difference in freedom from LVAD or transplant between men and women (Fig 1). Conclusion Black patients and women may have a less robust response to milrinone than their counterparts, and black patients may be referred for LVAD or transplant less quickly than patients of other race. Additional studies are needed to determine if pharmacogenomics and implicit bias may play a role in these results.
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PURPOSE In heart transplant (HT) patients, prevalence of BK virus (BKV) infection and its clinical significance are unknown. We sought to understand rates of BKV infection in a large HT cohort and to evaluate risk factors and effects of... more
PURPOSE In heart transplant (HT) patients, prevalence of BK virus (BKV) infection and its clinical significance are unknown. We sought to understand rates of BKV infection in a large HT cohort and to evaluate risk factors and effects of infection. METHODS Consecutive HT patients at a single institution were evaluated for BKV infection in blood and urine in the 1st year post-transplant. Titers were collected 1-month post-transplant and then every 6 months, with additional testing if needed. Rates of infection were compared between HT and combined organ transplant. In the HT group, patients with no infection, viruria with no viremia, and viremia with or without viruria were compared. Measures of immunity and kidney function were collected with titers in blood to evaluate Spearman rank correlations using log10 transformation. RESULTS 104 patients were enrolled: 89 HT, 12 heart/kidney transplant (HKT), 1 heart/liver transplant, 2 heart/liver/kidney transplant. Viruria and viremia were highly prevalent in HT (42% and 30%, respectively). Compared to HT patients without infection, those with viremia were older (57.8 vs 50.8 yrs, p=0.04), and tended to have lower pre-transplant glomerular filtration rate (GFR) (63.3 vs 71.4 mg/dL/1.73m2, p=0.14). There were no significant differences between patients with viruria compared to viremia. 1-year freedom from viruria was 55% in HT vs 46% in HKT. 1-year freedom from viremia was 67% in HT vs 56% in HKT (Figure). Viremia titers in HT strongly correlated with immunoglobulin (IgG) levels (R= -0.60, p=0.001), but not other immunity measures. Viremia titers were not correlated with GFR (R= 0.05, p=0.70). When comparing GFR before transplant to 1-year post-transplant, there was no significant difference found in the groups with no infection, viruria, and viremia (-22.4 vs -23.7 vs -23.4 mg/dL/1.73m2, p=0.98). CONCLUSION BK viremia is very common in HT patients. BK viremia correlated with IgG, but not kidney function. Longer surveillance studies are needed to evaluate effects of BKV infection.
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PURPOSE We hypothesized that a novel invasive hemodynamic measure reflecting cardiac contractility and filling pressure would predict long-term prognosis. METHODS We retrospectively analyzed consecutive patients undergoing right heart... more
PURPOSE We hypothesized that a novel invasive hemodynamic measure reflecting cardiac contractility and filling pressure would predict long-term prognosis. METHODS We retrospectively analyzed consecutive patients undergoing right heart catheterization (RHC) with milrinone drug study at our institution between 2/2013-2/2017. In addition to usual RHC measurements aortic pulsatility index (API) was calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure. Univariate and multivariate logistic regression analyses were conducted to determine association with continued medical management (MM) compared to advanced therapies (AT), defined as the combined endpoint of progression to left ventricular assist device, orthotopic heart transplant or need for inotropes, or death at 30 days and 1 year. RESULTS A total of 120 patients (33% female, average age 57 ± 13 years, 45% ischemic cardiomyopathy) were included in the analysis. Baseline API was higher in patients on MM at 30-days and 1-year post-RHC, OR 2.6 (95% CI 1.6-4.5,p<0.001), OR 3.1 (95% CI 1.7-5.6,p<0.001), respectively, compared to those that progressed to AT or death. In univariate analysis a 1-point increase in API was associated with increased odds of MM compared to progression to AT or death, OR 2.6 (95% CI 1.6-4.5,p<0.001), OR 3.1 (95% CI 1.7-5.6,p<0.001) at 30-day and 1-year follow-up, respectively. In multivariate analysis API was strongly associated with continued MM and freedom from AT or death when adjusted for Fick cardiac index and pulmonary artery pulsatility index at 30-days and 1-year, respectively, OR 2.4 (95% CI 1.3-4.3, p=0.004), OR 3.2 (95% CI 1.5-6.6,p=0.002). Change in API after milrinone infusion was not significantly associated with MM at 30-day or 1-year follow-up. CONCLUSION API is a novel invasive hemodynamic measurement that better predicts freedom from AT or death at 30-day and 1-year follow-up when compared to traditional RHC measurements.
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PURPOSE De novo donor-specific antibody (DSA) production has been correlated to the development of antibody-mediated rejection after heart transplantation. It is unclear whether the Cylex ImmuKnow (IK) assay - a rapid, quantitative... more
PURPOSE De novo donor-specific antibody (DSA) production has been correlated to the development of antibody-mediated rejection after heart transplantation. It is unclear whether the Cylex ImmuKnow (IK) assay - a rapid, quantitative assessment of T-cell-mediated immune function designed to monitor immunosuppression response - can be a useful tool in overall immunosuppression and identification of patients at risk for de novo DSA production. We hypothesize that, among heart transplant recipients, increased immune function activity as measured by the IK assay would correlate with de novo DSA production. METHODS We conducted a single center cohort study including all consecutive single organ heart transplant recipients from 2014 to 2018. The IK assay categorized subjects into low, moderate, or high immune response levels at 6, 12, and 24-month intervals. De novo DSA production based on human leukocyte antigen antibody testing was correlated to IK immune response levels at these time points. RESULTS 122 single organ heart transplant recipients were included. High immune response levels were noted in 10%, 9%, and 12% of subjects at 6, 12, and 24-months, respectively. Compared to baseline, de novo DSA production was noted in 21%, 23%, and 25% of subjects at the respective time intervals. 6-month IK category did not correlate with DSA production at 6 (r = -0.03, p=0.9), 12 (r = -0.03, p=0.9), or 24 months (r = 0.15, p=0.3). Similar findings were noted at 12 and 24 months. Being in a high IK category at any interval was not associated with de novo DSA production at any time point (p>0.05). Univariate analysis of demographic factors, induction agents used, and co-morbidities (including EMV or CBV infection status) did not reveal significant associations with de novo DSA production. CONCLUSION High T-cell-mediated immune response levels, a possible indicator of under-suppression, as measured by the IK assay were not associated with de novo DSA production after heart transplantation.
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Introduction Evaluating the applicability of a clinical trial to a specific patient is difficult. A novel framework, the Trial Score, was created to quantify the generalizability of a trial's result based on participants' baseline... more
Introduction Evaluating the applicability of a clinical trial to a specific patient is difficult. A novel framework, the Trial Score, was created to quantify the generalizability of a trial's result based on participants' baseline characteristics and not on the trial's inclusion and exclusion criteria. Methods For each Systolic Blood Pressure Intervention Trial (SPRINT) participant, the Euclidean distance in six-dimensional space from the theoretical “average” participant was calculated to produce an individual Trial Score that incorporates multiple distinct continuous-variable baseline characteristics. We prospectively defined the “data-rich,” “data-limited,” and “data-free” zones as Trial Scores 97.5th percentile, respectively. Trial Scores were then calculated for National Health and Nutrition Examination Survey participants to map data zones of the general population. Individual participant data from the Action to Control Cardiovascular Risk in Diabetes blood pressur...
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Neutropenia is a significant adverse event after heart transplantation (HT) and increases infection risk. Granulocyte colony-stimulating factor (G-CSF) is commonly used in patients with neutropenia. In this work, we assessed the adverse... more
Neutropenia is a significant adverse event after heart transplantation (HT) and increases infection risk. Granulocyte colony-stimulating factor (G-CSF) is commonly used in patients with neutropenia. In this work, we assessed the adverse effects of G-CSF treatment in the setting of a university hospital. Data on HT patients from January 2008 to July 2016 were reviewed. Patients who received G-CSF were identified and compared with patients without a history of therapy. Baseline characteristics, rejection episodes, and outcomes were collected. Data were analyzed by incidence rates, time to rejection and survival were analyzed using Kaplan-Meier curves, and odds ratios were generated using logistic regression analysis. Two hundred twenty-two HT patients were studied and 40 (18%) received G-CSF for a total of 85 total neutropenic events (0.79 event/patient year). There were no differences in baseline characteristics between the groups. In the 3 months after G-CSF, the incidence rate of r...
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Research Interests: Cardiology, Magnetic Resonance Imaging, Medicine, Electrocardiography, Echocardiography, and 14 moreHumans, Internal Medicine, Female, The, Differential Diagnosis, Aged, Coronary Angiography, Cardiac Imaging, Cardiovascular Imaging, Cardiomyopathy, Contrast Media, Takotsubo cardiomyopathy, acute phase, and Cardiovascular medicine and haematology
Research Interests: Cardiology, Medicine, Prospective studies, Humans, Internal Medicine, and 12 moreFemale, Male, Atrial Fibrillation, Mitral Valve Repair, Clinical Sciences, Aged, Middle Aged, Proportional Hazards Models, Logistic Models, Postoperative Complications, Cardiovascular medicine and haematology, and Mitral valve
The authors used transthoracic 3-dimensional transthoracic echocardiography (3DE) to characterize tricuspid annulus (TA) geometry and dynamics in healthy volunteers. Accurate sizing of the TA is essential for planning tricuspid... more
The authors used transthoracic 3-dimensional transthoracic echocardiography (3DE) to characterize tricuspid annulus (TA) geometry and dynamics in healthy volunteers. Accurate sizing of the TA is essential for planning tricuspid annuloplasty and for implantation of new percutaneous tricuspid devices. 3DE of the TA from 209 healthy volunteers was analyzed using custom software to measure TA area, perimeter, circularity, and dimensions at end diastole (equals tricuspid valve closure), mid-systole, end systole, and late diastole. TA intercommissural distances were measured at mid-systole. For comparison, TA diameters were measured at the same time points on multiplanar reconstruction of the 3DE datasets and on 2-dimensional transthoracic echocardiography (2DE) apical 4-chamber and right ventricular focused views. In 13 subjects with both 3DE and computed tomography, TA parameters were compared. 3DE TA area, perimeter, and dimensions were largest in late diastole and smallest at mid-syst...
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This study hypothesized that left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) derived from 3-dimensional echocardiographic (3DE) images would better predict mortality than those obtained by 2-dimensional... more
This study hypothesized that left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) derived from 3-dimensional echocardiographic (3DE) images would better predict mortality than those obtained by 2-dimensional echocardiographic (2DE) measurements, and that 3DE-based LV shape analysis may have added prognostic value. Previous studies have shown that both LVEF and GLS derived from 2DE images predict mortality. Recently, 3DE measurements of these parameters were found to be more accurate and reproducible because of independence of imaging plane and geometric assumptions. Also, 3DE analysis offers an opportunity to accurately quantify LV shape. We retrospectively studied 416 inpatients (60 ± 18 years of age) referred for transthoracic echocardiography between 2006 and 2010, in whom good-quality 2DE and 3DE images were available. Mortality data through 2016 were collected. Both 2DE and 3DE images were analyzed to measure LVEF and GLS. Additionally, 3DE-derived ...
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Background: Rapid clinical assessment and accurate ECG interpretation are requisites to ensure expeditious initiation of reperfusion therapy in patients (pts) with presumed ST elevation myocardial ...
Research Interests: Medicine and Circulation
Background: Myocardial ischemia occurs during myocardial infarction results in the stabilization of Hypoxia-inducible factors (HIFs). Hif2α expresses profoundly in vascular endothelial cells (EC), and its embryonic deletion increases... more
Background: Myocardial ischemia occurs during myocardial infarction results in the stabilization of Hypoxia-inducible factors (HIFs). Hif2α expresses profoundly in vascular endothelial cells (EC), and its embryonic deletion increases vessel permeability. It has been shown that HIF2a is protective from renal and pulmonary injury. However, the direct role of ecHIF2α in ischemia heart disease is unknown. We hypothesized that ecHIF2a expression in response to myocardial infarction (MI) protects cardiac barrier dysfunction and against heart failure. Methods and Results: We generated the Inducible endothelial-specific knockout mice (ecHIF2a -/- ) by crossing Hif2a flox/flox mice with Cre ERT2 mice under the VE-cadherin promoter. Followed with MI, ecHIF2a -/- mice displayed worsened cardiac function determined by echocardiography, and they had increased mortality as compared to the controls. In vitro, we used primary mouse cardiac microvascular endothelial cells (mCMVEC) from ecHIF2a -/- m...
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120 mmHg is an optimal SBP goal according to the SPRINT trial. However, certain inclusion and exclusion criteria cloud its broad applicability. It is critical to understand which patients are well ...
Research Interests: Medicine and Hypertension
Background: Dual antiplatelet therapy (aspirin plus clopidogrel/ticagrelor - DAPT) is a mainstay treatment for NSTEMI. However, studies suggest that early administration of clopidogrel may not conf...
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Introduction: Patients living in high-crime areas often have hypertension. However, the spatiotemporal effect of violent crime events, particularly changes from local baseline crime rates, on an in...
Research Interests: Medicine and Circulation
While many interventions to reduce hospital admissions and emergency department (ED) visits for patients with cardiovascular disease have been developed, identifying ambulatory cardiac patients at high risk for admission can be challenging.
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Introduction: People living in areas with high rates of crime tend to have high rates of hypertension. This association can be explained, in part, by allostatic load theory, which describes how blood pressure can respond to exogenous... more
Introduction: People living in areas with high rates of crime tend to have high rates of hypertension. This association can be explained, in part, by allostatic load theory, which describes how blood pressure can respond to exogenous stress over time. However, little is known about the immediate impact of rising crime rates on blood pressure (BP), and how this relationship may differ for patients living in typically low- vs. high-crime areas. Hypothesis: Rising violent crime rates are associated with a larger increase in BP for patients living in typically low-crime areas than for patients living in typically high-crime areas. Methods: A surge in Chicago’s violent crime rates in 2015 created natural conditions to implement a difference-in-differences analysis, to examine contemporaneous changes in BP in low- and high-crime census tracts. We analyzed the health records of patients, aged 18 years and older, seen in outpatient clinics at an academic medical center between May 2014 and ...
Research Interests: Medicine and Circulation
BACKGROUND Atrial arrhythmias following hematopoietic stem cell transplantation (HSCT) have been associated with increased length of stay, need for intensive care, and increased mortality within one-year post-transplant. We sought to... more
BACKGROUND Atrial arrhythmias following hematopoietic stem cell transplantation (HSCT) have been associated with increased length of stay, need for intensive care, and increased mortality within one-year post-transplant. We sought to identify echocardiographic parameters that may predict the development of new atrial arrhythmias post-HSCT. METHODS We performed a retrospective chart review of 753 consecutive patients who underwent HSCT at the University of Chicago from January 2015 through December 2019. Patients with baseline echocardiogram within 6 months prior to transplantation were included. Those with prior transplants, history of atrial arrhythmias, or unavailable echocardiographic images were excluded, resulting in 187 patients included for final analysis. Baseline clinical and demographic variables, as well as echocardiographic parameters, were compared between patients who developed new atrial arrhythmias post-HSCT versus those who did not. RESULTS Of the 187 patients inclu...
Research Interests: Cardiology and Medicine
INTRODUCTION Hypertension is associated with adverse cardiovascular outcomes and is geographically concentrated in urban underserved neighborhoods. This study examines the temporal-spatial association between individual exposure to... more
INTRODUCTION Hypertension is associated with adverse cardiovascular outcomes and is geographically concentrated in urban underserved neighborhoods. This study examines the temporal-spatial association between individual exposure to violent crime and blood pressure. METHODS A retrospective observational cohort study analyzed 39,211 patients with 227,595 blood pressure measurements from 2014 to 2016 at 3 outpatient clinics at an academic medical center in Chicago. Patients were included in the study if they had documentation of blood pressure in the medical record and resided in census tracts with >1,000 observations. Geocoded violent crime events were obtained from the Chicago Police Department. Individual-level exposure was defined on the basis of spatial and temporal buffers around each patient's home. Spatial buffers included 100-, 250-, 500-, and 1,000-meter disc radii, and temporal buffers included 7, 30, and 60 days preceding each outpatient appointment. Systolic blood p...
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Introduction: The onus of facilitating timely reperfusion therapy among STEMI patients ultimately depends on the clinical evaluation and electrocardiographic (ECG) interpretation. False activation (FA) can potentially lead to... more
Introduction: The onus of facilitating timely reperfusion therapy among STEMI patients ultimately depends on the clinical evaluation and electrocardiographic (ECG) interpretation. False activation (FA) can potentially lead to inappropriate treatment and predispose to incremental treatment-related risks, but the evidence in this regard is lacking. Methods: In this prospective observational study we analyzed the FA rate between 1/2005-12/2014 among 4123 consecutive presumed STEMI pts, managed within a regional STEMI reperfusion program in Central and Southern Illinois. The FA pts was defined as those not meeting the ECG, laboratory and coronary angiographic definition of STEMI. They were further classified as “inappropriately” triaged when retrospective review of the activating ECG showed no evidence of characteristic STEMI changes, or “appropriately” triaged when the activating ECG showed STEMI changes without a corresponding infarct related artery on the angiogram. Ten-year mortalit...
Late gadolinium enhancement (LGE) imaging in patients with implantable cardioverter‐defibrillators (ICD) is limited by device‐related artifacts (DRA). The use of wideband (WB) LGE protocols improves LGE images, but their efficacy with... more
Late gadolinium enhancement (LGE) imaging in patients with implantable cardioverter‐defibrillators (ICD) is limited by device‐related artifacts (DRA). The use of wideband (WB) LGE protocols improves LGE images, but their efficacy with different ICD types is not well known.
As clinicians have gained experience in treating patients with the novel SARS-CoV-2 (COVID-19) virus, mortality rates for patients with acute COVID-19 infection have decreased. The Centers for Disease Control (CDC) has identified the... more
As clinicians have gained experience in treating patients with the novel SARS-CoV-2 (COVID-19) virus, mortality rates for patients with acute COVID-19 infection have decreased. The Centers for Disease Control (CDC) has identified the African American population as having increased risk of COVID-19 associated mortality, however little is known about echocardiographic markers associated with increased mortality in this patient population. We aimed to compare the clinical and echocardiographic features of a predominantly African American patient cohort hospitalized with acute COVID-19 infection during the first (March–June 2020) and second (September–December 2020) waves of the COVID-19 pandemic, and to investigate which parameters are most strongly associated with composite all-cause mortality. We performed consecutive transthoracic echocardiograms (TTEs) on 105 patients admitted with acute COVID-19 infection during the first wave and 129 patients admitted during the second wave. TTE ...
OBJECTIVE Coronary microvascular dysfunction (CMD) is a new frontier in cardiovascular disease and an important contributor to myocardial ischemia. A high prevalence of CMD is shown in heart failure, however, the cause-and-effect... more
OBJECTIVE Coronary microvascular dysfunction (CMD) is a new frontier in cardiovascular disease and an important contributor to myocardial ischemia. A high prevalence of CMD is shown in heart failure, however, the cause-and-effect relationship between CMD and atrial fibrillation (AF) is unknown. We hypothesize that CMD is associated with AF and increases susceptibility to the co-existence of AF and heart failure with preserved ejection fraction (HFpEF). METHODS Our study examined the relationship between CMD, AF, and HFpEF in all patients who underwent invasive coronary physiology studies for assessment of chest pain or dyspnea. CMD was defined as impaired coronary flow reserve (CFR) without obstructive coronary disease. RESULTS A total of 80 patients (mean age 60±12 years, 68.8% female, median follow up of 2.2 years) were studied. Patients with AF (61%) or HFpEF (62%), or both (71%) were more likely to have CMD than those patients without these conditions. Of the patients with AF an...
Background: Recent studies have suggested that inherent process delays associated with a universal reperfusion strategy of inter-hospital transfer of ST elevation myocardial infarction (STEMI) patients (pts) for primary PCI (pPCI) may... more
Background: Recent studies have suggested that inherent process delays associated with a universal reperfusion strategy of inter-hospital transfer of ST elevation myocardial infarction (STEMI) patients (pts) for primary PCI (pPCI) may adversely affect clinical outcomes compared to pts directly admitted to a pPCI facility. However, long-term clinical outcomes associated with inter-hospital STEMI reperfusion strategies incorporating pPCI and selective use of pharmacologic reperfusion (FIB) is poorly described. Methods: In this prospective, observational study we define the 10-year mortality among 3,117 consecutive STEMI pts directly admitted (n=1,188; 38%) to 3 pPCI facilities or undergoing inter-hospital transfer (n=1,929; 62%) within an integrated program from 31 rural STEMI-referral hospitals in Central and Southern Illinois between 1/2005 and 12/2014. The inter-hospital transfer STEMI program used a pre-defined reperfusion protocol with emergent transfer for pPCI or use of "t...
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Background Hospitalizations in patients with heart failure (HF) remain high despite advances in treatment. While implantable pulmonary artery pressure monitors (Abbott CardioMEMS) reduce readmissions in largely white and male cohorts,... more
Background Hospitalizations in patients with heart failure (HF) remain high despite advances in treatment. While implantable pulmonary artery pressure monitors (Abbott CardioMEMS) reduce readmissions in largely white and male cohorts, their efficacy in poor, minority populations are not known. We hypothesized that a nurse-driven program using the CardioMEMS device could reduce HF hospitalizations in such patients. Methods 22 high-utilizing patients (86% non-white, 55% female) with NYHA Class III HF were implanted with a CardioMEMS following a hospital admission for HF. Data from the CardioMEMS guided a speciallytrained nurse in adjusting medications. Enrolled patients were matched using 30 clinical and demographic variables with contemporaneous control HF patients who received usual care. Each patient's hospitalizations were recorded for 6 months and compared using Fisher's exact test. Results Patients who received a CardioMEMS experienced a 61% decrease in HF-related readmission and a 70% reduction in HF-related ED visits (p Conclusion A nurse-driven CardioMEMS program reduces HF-related hospitalization and ED visits among high-risk, low-socioeconomic, urban patients.
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Introduction Current evidence suggests that high sensitivity cardiac troponin-T (hs-cTnT) values differ based on sex, race, age, and kidney function. However, most studies examining the relationship of hs-cTnT and these individual factors... more
Introduction Current evidence suggests that high sensitivity cardiac troponin-T (hs-cTnT) values differ based on sex, race, age, and kidney function. However, most studies examining the relationship of hs-cTnT and these individual factors are in healthy participants, leading to difficulty in interpreting hs-cTnT values in the Emergency Department (ED) setting. We seek to examine the relationship between hs-cTnT values and sex, race, age, and kidney function in a contemporary, urban academic setting. Methods ED visits from June 2018 through April 2019 with at least 1 hs-cTnT and no diagnosis of acute myocardial infarction (AMI) at an academic medical center in the south side of Chicago were retrospectively analyzed. Median hs-cTnT values were stratified by sex (male or female), race (African American or Caucasian), age, estimated glomerular filtration rate (eGFR), and stage of chronic kidney disease. Results 9679 encounters, representing 7989 distinct patients, were included for anal...