Clinical Cardiology
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Superior vena caval obstruction by lipomatous hypertrophy of the right atrium Abstract A structural abnormality was suspected when passage of a Swan‐Ganz catheter was obstructed at the distal superior vena cava (SVC). At autopsy, lipomatous hypertrophy of the right atrium markedly narrowed the lumen at the SVC‐right atrial junction.
Clinical Cardiology - Tập 10 Số 10 - Trang 609-610 - 1987
Cardio‐Oncology/Onco‐Cardiology Abstract An understanding of onco‐cardiology or cardio‐oncology is critical for the effective care of cancer patients. Virtually all antineoplastic agents are associated with cardiotoxicity, which can be divided into 5 categories: direct cytotoxic effects of chemotherapy and associated cardiac systolic dysfunction, cardiac ischemia, arrhythmias, pericarditis, and chemotherapy‐induced repolarization abnormalities. Radiation therapy can also lead to coronary artery disease and fibrotic changes to the valves, pericardium, and myocardium. All patients being considered for chemotherapy, especially those who have prior cardiac history, should undergo detailed cardiovascular evaluation to optimize the treatment. Serial assessment of left ventricular systolic function and cardiac biomarkers might also be considered in selected patient populations. Cardiotoxic effects of chemotherapy might be decreased by the concurrent use of angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, or beta‐blockers. Antiplatelet or anticoagulation therapy might be considered in patients with a potential hypercoagulable state associated with chemotherapy or cancer. Open dialogue between both cardiologists and oncologists will be required for optimal patient care. Copyright © 2010 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.
Clinical Cardiology - Tập 33 Số 12 - Trang 733-737 - 2010
A Case of giant cell myocarditis and malignant thymoma: A postmortem diagnosis by needle biopsy Abstract This paper reports a case of fulminant giant cell myocarditis arising in association with a malignant thymoma causing death in a 46‐year‐old woman. Although the diagnosis was suspected in life, postmortem examination was required for confirmation of giant cell myocarditis. Consent was obtained only for percutaneous needle biopsy of the heart. In order to respect the family's wishes and harvest sufficient diagnostic myocardium, a simple needle‐based biopsy technique was devised. A bone marrow trephine needle was attached to a 20 ml syringe and, with suction, multiple passes were used to fill 15 tissue cassettes. The cores were placed immediately in formalin and B5 fixatives. High‐quality tissue preservation was obtained without crush artefact. Immunohistochemical studies of the biopsy tissue confirmed that the giant cells were of macrophage derivation.
Clinical Cardiology - Tập 21 Số 1 - Trang 48-51 - 1998
The contemporary value of peak creatine kinase‐<scp>MB</scp> after <scp>ST</scp>‐segment elevation myocardial infarction above other clinical and angiographic characteristics in predicting infarct size, left ventricular ejection fraction, and mortality Background Complex multimarker approaches to predict outcome after ST ‐elevation myocardial infarction (STEMI ) have only considered a single baseline sample, while neglecting easily obtainable peak creatine kinase and creatine kinase‐MB (CK‐MB ) values during hospitalization. Methods We studied 476 patients undergoing primary percutaneous coronary intervention for STEMI and cardiac magnetic resonance imaging (CMRI ) at 4‐6 months after STEMI . We determined the association with cardiac biomarkers (peak CK‐MB , peak troponin T, N‐terminal pro‐brain natriuretic peptide), clinical and angiographic characteristics with infarct size, and LVEF , followed by association with mortality in 1120 STEMI patients. Results Peak CK‐MB was the strongest predictor for infarct size (P <0.001, R
2 =0.60) and LVEF (P <0.001, R
2 =0.40). The additional value of clinical and angiographic characteristics was limited. The optimal peak CK‐MB cutpoints, for differentiation among small (<10% of the left ventricle), moderate (≥10%–<30%), and large infarct size (≥30%), were 210 U/L and 380 U/L, respectively. These cutpoints were associated with 90‐day mortality; the hazard ratio for moderate infarct was 2.99 (95% confidence interval [CI]: 1.51‐5.93, P =0.002) and for large infarct 6.53 (95% CI: 3.63‐11.76, P <0.001). Conclusions Classical peak CK‐MB measured during hospitalization for STEMI was superior to other clinical and angiographic characteristics in predicting CMRI‐defined infarct size and LVEF, and should be included and validated in future multimarker studies. Peak CK‐MB cutpoints differentiated among infarct size categories and were associated with increased 90‐day mortality risk.
Clinical Cardiology - Tập 40 Số 5 - Trang 322-328 - 2017
Assessment of American Heart Association's Ideal Cardiovascular Health Metrics Among Employees of a Large Healthcare Organization: The Baptist Health South Florida Employee Study ABSTRACT Background Healthcare organizations and their employees are critical role models for healthy living in their communities. The American Heart Association (AHA ) 2020 impact goal provides a national framework that can be used to track the success of employee wellness programs with a focus on improving cardiovascular (CV ) health. This study aimed to assess the CV health of the employees of Baptist Health South Florida (BHSF ), a large nonprofit healthcare organization. Hypothesis HRAs and wellness examinations can be used to measure the cardiovascular health status of an employee population. Methods The AHA 's 7 CV health metrics (diet, physical activity, smoking, body mass index, blood pressure, total cholesterol, and blood glucose) categorized as ideal, intermediate, or poor were estimated among employees of BHSF participating voluntarily in an annual health risk assessment (HRA ) and wellness fair. Age and gender differences were analyzed using χ2 test. Results The sample consisted of 9364 employees who participated in the 2014 annual HRA and wellness fair (mean age [standard deviation], 43 [12] years, 74% women). Sixty (1%) individuals met the AHA 's definition of ideal CV health. Women were more likely than men to meet the ideal criteria for more than 5 CV health metrics. The proportion of participants meeting the ideal criteria for more than 5 CV health metrics decreased with age. Conclusions A combination of HRAs and wellness examinations can provide useful insights into the cardiovascular health status of an employee population. Future tracking of the CV health metrics will provide critical feedback on the impact of system wide wellness efforts as well as identifying proactive programs to assist in making substantial progress toward the AHA 2020 Impact Goal.
Clinical Cardiology - Tập 38 Số 7 - Trang 422-429 - 2015
Independent Association Between Obstructive Sleep Apnea and Noncalcified Coronary Plaque Demonstrated by Noninvasive Coronary Computed Tomography Angiography Abstract Background: Coronary artery atherosclerosis has been associated with obstructive sleep apnea (OSA). However, the type and severity of plaque formation have not been characterized. This study evaluated the association of coronary noncalcified plaques and severity of stenosis in patients with OSA. Hypothesis: Methods: This study was a retrospective analysis of 81 patients, 49 with OSA and 32 without OSA, who had undergone multidetector‐row helical computed tomography scanning. The board‐certified radiologist was blinded to the diagnosis of OSA and reviewed the scans for plaque characterization, severity of stenosis, and number of vessels involved. Results: Of the 81 patients reviewed, the mean apnea‐hypopnea index in the OSA group was 42.2 vs 7.5 in the non‐OSA group. The groups did not significantly differ in the distribution of comorbid conditions. We found that among the patients with OSA, 63% had noncalcified/mixed plaques, as opposed to 16% in the non‐OSA group (P < 0.0001), with unadjusted odds ratio of 9.3 (3.0, 28.4). After adjustment for other risk factors such as age, sex, race, hypercholesterolemia, and history of smoking, the association remained strong, with an odds ratio of 7.0 (1.9, 26.5; P < 0.05). Conclusions: Our study finds that the frequency of noncalcified/mixed plaques is much higher in patients with OSA than in non‐OSA patients. Patients with OSA also have more severe stenosis and a higher number of vessels involved. This study adds to a growing body of data regarding our understanding of the association of OSA and atherosclerosis. Dr. Sharma, Dr. Schoepf, Mr. Parker, Mr. Abro, and Mr. Armstrong contributed to data collection and analysis, drafting of the manuscript, and final approval. Dr. Gebregziabher contributed to data analysis, drafting of the manuscript, and final approval. Dr. Sharma had access to and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors of this manuscript have certified that they comply with the principles of ethical publishing (Shewan LG, Coats AJ. Ethics in the authorship and publishing of scientific articles. Int J Cardiol. 2010;144:1‐2.). The authors have no funding, financial relationships, or conflicts of interest to disclose.
Clinical Cardiology - Tập 35 Số 10 - Trang 641-645 - 2012
“Missing” acute coronary syndrome hospitalizations during the <scp>COVID</scp>‐19 era in Greece: Medical care avoidance combined with a true reduction in incidence? Abstract Background Reports from countries severely hit by the COVID‐19 pandemic suggest a decline in acute coronary syndrome (ACS)‐related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID‐19 incidence are not known. Hypothesis ACS admissions were reduced in a country spared by COVID‐19. Methods We conducted a nationwide study on the incidence rates of ACS‐related admissions during a 6‐week period of the COVID‐19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID‐19 incidence, and no excess in mortality. Results ACS admissions in the COVID‐19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72, P < .001) and for each ACS type (ST‐segment elevation myocardial infarction [STEMI]: IRR: 0.76, P = .001; non‐STEMI: IRR: 0.74, P < .001; and unstable angina [UA]: IRR: 0.63, P = .002). The decrease in STEMI admissions was stable throughout the COVID‐19 period (temporal correlation; R2 = 0.11, P = .53), whereas there was a gradual decline in non‐STEMI/UA admissions (R2 = 0.75, P = .026) following the progressively stricter social measures. During the COVID‐19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period; P < .001). Conclusions We observed a reduction in ACS hospitalizations during the COVID‐19 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self‐isolation/quarantining may have also played a role.
Clinical Cardiology - Tập 43 Số 10 - Trang 1142-1149 - 2020
Approaches to determination of left ventricular volume and ejection fraction by real‐time two‐dimensional echocardiography Abstract Left ventricular volumes and ejection fraction were derived from real time two‐dimensional echocardio‐graphic images (2 DE) and single plane (RAO) left ventricular cineangiograms in a series of 50 patients. Prospective application of a series of 6 alternate algorithms showed that a modified Simpson's rule approach using mitral and papillary muscle cross sections and an apical four chamber view provided the best 2 DE — angiographic correlations: for end‐diastolic volume r = 0.82, SEE = 39 ml; for end‐systolic volume r = 0.90, SEE = 29 ml and for ejection fraction r = 0.80, SEE = 0.09. The large SEE for volume determination indicates that further refinements are necessary to predict left ventricular volumes adequately; however, ejection fraction can be derived with an accuracy which allows practical clinical decisions in patients with satisfactory 2 DE images.
Clinical Cardiology - Tập 2 Số 4 - Trang 257-263 - 1979
2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non–ST‐Elevation Myocardial Infarction (Updating the 2007 Guideline): Highlights for the Clinician Abstract The 2011 Update to the Unstable Angina/Non–ST‐Elevation Myocardial Infarction (UA/NSTEMI) Guideline is based in evolving data or expert opinion and incorporates information from late‐breaking clinical trials presented at the 2008–2009 Scientific Sessions of the American College of Cardiology, the American Heart Association, and the European Society of Cardiology, among others, as well as selected data through April 2010. The 5 key issues highlighted in this summary are: (1) the timing of acute interventional therapy in non–ST‐elevation myocardial infarction; (2) emphasis on the timing, duration, and application of dual and triple antiplatelet therapy; (3) specific recommendations for patients with diabetes mellitus; (4) the role and potential benefit of invasive therapy in patients with advanced renal dysfunction; and (5) issues of quality improvement for acute coronary syndromes. © 2011 Wiley Periodicals, Inc. Dr. Wenger is a consultant at Emory Heart and Vascular Center, Atlanta, Georgia. The author has no other funding, financial relationships, or conflicts of interest to disclose.
Clinical Cardiology - Tập 35 Số 1 - Trang 3-8 - 2012
Relationship between electrocardiographically estimated infarct size and clinical findings in anterior myocardial infarction Abstract In 292 patients with anterior myocardial infarction (MI) and no previous MI the electrocardiographically estimated infarct size was correlated with clinical findings during hospitalization and 3‐month follow‐up. Patients with ECG‐defined transmural MI had a higher incidence of different types of complications, such as congestive heart failure (CHF), hypotension, pericarditis, and a longer duration of hospitalization than patients with nontransmural MI. In a subgroup including 182 patients of the total series, a precordial map containing 24 electrodes was used. The sum of R waves (ΣR), the sum of Q waves (ΣQ), the number of Q waves, and ΣR‐ΣQ were calculated 4 days after arrival in hospital to estimate the size of infarction. There was generally a correlation between these ECG variables and different clinical findings, such as incidence of CHF, hypotension, pericarditis, and the duration of hospitalization. It is concluded that the ECG determined infarct size in anterior MI in a majority of patients correlates with the incidence of different types of complications in acute myocardial infarction. In the individual patient, however, the risk of developing complications cannot be predicted by ECG changes.
Clinical Cardiology - Tập 7 Số 4 - Trang 217-227 - 1984
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