Showing papers by "Kim A. Eagle published in 2015"

Multimodality imaging of diseases of the thoracic aorta in adults: From the American society of echocardiography and the european association of cardiovascular imaging: Endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance

Abstract: Steven A. Goldstein, MD, Co-Chair, Arturo Evangelista, MD, FESC, Co-Chair, Suhny Abbara, MD, Andrew Arai, MD, Federico M. Asch, MD, FASE, Luigi P. Badano, MD, PhD, FESC, Michael A. Bolen, MD, Heidi M. Connolly, MD, Hug Cu ellar-Cal abria, MD, Martin Czerny, MD, Richard B. Devereux, MD, Raimund A. Erbel, MD, FASE, FESC, Rossella Fattori, MD, Eric M. Isselbacher, MD, Joseph M. Lindsay, MD, Marti McCulloch, MBA, RDCS, FASE, Hector I. Michelena, MD, FASE, Christoph A. Nienaber, MD, FESC, Jae K. Oh, MD, FASE, Mauro Pepi, MD, FESC, Allen J. Taylor, MD, Jonathan W. Weinsaft, MD, Jose Luis Zamorano, MD, FESC, FASE, Contributing Editors: Harry Dietz, MD, Kim Eagle, MD, John Elefteriades, MD, Guillaume Jondeau, MD, PhD, FESC, Herv e Rousseau, MD, PhD, and Marc Schepens, MD, Washington, District of Columbia; Barcelona and Madrid, Spain; Dallas and Houston, Texas; Bethesda and Baltimore, Maryland; Padua, Pesaro, and Milan, Italy; Cleveland, Ohio; Rochester, Minnesota; Zurich, Switzerland; New York, New York; Essen and Rostock, Germany; Boston, Massachusetts; Ann Arbor, Michigan; New Haven, Connecticut; Paris and Toulouse, France; and Brugge, Belgium

Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry.

Abstract: Background—Despite the known association of diabetes mellitus with cardiovascular events, there are few contemporary data on the long-term outcomes from international cohorts of patients with diabetes mellitus. We sought to describe cardiovascular outcomes at 4 years and to identify predictors of these events in patients with diabetes mellitus. Methods and Results—The Reduction of Atherothrombosis for Continued Health (REACH) registry is an international registry of patients at high risk of atherothrombosis or established atherothrombosis. Four-year event rates in patients with diabetes mellitus were determined with the corrected group prognosis method. Of the 45 227 patients in the REACH registry who had follow-up at 4 years, 43.6% (n=19 699) had diabetes mellitus at baseline. The overall risk and hazard ratio (HR) of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke were greater in patients with diabetes compared with patients without diabetes (16.5% versus 13.1%; adjusted HR, 1.2...

The Relationship between Childhood Obesity, Low Socioeconomic Status, and Race/Ethnicity: Lessons from Massachusetts.

Abstract: Background: Previous studies have shown race/ethnicity, particularly African American and/or Hispanic status, to be a predictor of overweight/obese status in children. However, these studies have failed to adjust for low socioeconomic status (SES). This study assessed whether race/ethnicity remained an independent predictor of childhood obesity when accounting for variations in SES (low-income) among communities in Massachusetts. Methods: This study was based on 2009 summarized data from 68 Massachusetts school districts with 111,799 students in grades 1, 4, 7, and 10. We studied the relationship between the rate of overweight/obese students (mean = 0.32; range = 0.10–0.46), the rate of African American and Hispanic students (mean = 0.17; range = 0.00–0.90), and the rate of low-income students (mean = 0.27; range = 0.02–0.87) in two and three dimensions. The main effect of the race/ethnicity rate, the low-income rate, and their interaction on the overweight and obese rate was investigated by mult...

High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events

Abstract: Background While prior work has suggested that a high-grade atrioventricular block (HAVB) in the setting of an acute coronary syndrome (ACS) is associated with in-hospital death, limited information is available on the incidence of, and death associated with, HAVB in ACS patients receiving contemporary management. Methods and results The incidence of HAVB was determined within The Global Registry of Acute Coronary Events (GRACE). The clinical characteristics, in-hospital therapies, and outcomes were compared between patients with and without HAVB. Factors associated with death in patients with HAVB were determined. A total of 59 229 patients with ACS between 1999 and 2007 were identified; 2.9% of patients had HAVB at any point during the index hospitalization; 22.7% of whom died in hospital [adjusted odds ratio (OR) = 4.2, 95% confidence interval (CI), 3.6–4.9, P 12 h or no intervention) were associated with improved in-hospital survival, whereas temporary pacemaker insertion was not. Patients with HAVB surviving to discharge had similar adjusted survival at 6 months compared with those without HAVB. A reduction in the rate of, but not in-hospital mortality associated with, HAVB was noted over the study period. Conclusion Although the incidence of HAVB is low and decreasing, this complication continues to have a high risk of in-hospital death.

Survivors of Aortic Dissection: Activity, Mental Health, and Sexual Function.

Abstract: Background Currently no research exists assessing lifestyle modifications and emotional state of acute aortic dissection (AAD) survivors. We sought to assess activity, mental health, and sexual function in AAD survivors. Hypothesis Physical and sexual activity will decrease in AAD survivors compared to pre-dissection. Incidence of anxiety and depression will be significant after AAD. Methods A cross sectional survey was mailed to 197 subjects from a single academic medical center (part of larger IRAD database). Subjects were ≥18 years of age surviving a type A or B AAD between 1996 and 2011. 82 surveys were returned (overall response rate 42%). Results Mean age ± SD was 59.5 ± 13.7 years, with 54.9% type A and 43.9% type B patients. Walking remained the most prevalent form of physical activity (49 (60%) pre-dissection and 47 (57%) post-dissection). Physical inactivity increased from 14 (17%) before AAD to 20 (24%) after AAD; sexual activity decreased from 31 (38%) to 9 (11%) mostly due to fear. Most patients (66.7%) were not exerting themselves physically or emotionally at AAD onset. Systolic blood pressure (SBP) at 36 months post-discharge for patients engaging in ≥2 sessions of aerobic activity/week was 126.67 ± 10.30 vs. 141.10 ± 11.87 (p-value 0.012) in those who did not. Self-reported new-onset depression after AAD was 32% and also 32% for new-onset anxiety. Conclusions Alterations in lifestyle and emotional state are frequent in AAD survivors. Clinicians should screen for unfounded fears or beliefs after dissection that may reduce function and/or quality of life for AAD survivors.

Acute coronary syndrome in young women under 55 years of age: clinical characteristics, treatment, and outcomes.

Abstract: Background Young women with acute coronary syndrome (ACS) may represent a high risk group, but little is known about specific age and sex differences in clinical characteristics, treatment, outcomes, and trends over time.

Exercise and Physical Activity for the Post-Aortic Dissection Patient: The Clinician's Conundrum.

Abstract: Despite the paucity of evidence, it is often presumed, and is physiologically plausible, that sudden, acute elevations in blood pressure may transiently increase the risk of recurrent aortic dissection (AD) or rupture in patients with a prior AD, because a post-dissection aorta is almost invariably dilated and may thus experience greater associated wall stress as compared with a nondilated aorta. Few data are available regarding the specific types and intensities of exercise that may be both safe and beneficial for this escalating patient population. The purpose of this editorial/commentary is to further explore this conundrum for clinicians caring for and counseling AD survivors. Moderate-intensity cardiovascular activity may be cardioprotective in this patient cohort. It is likely that severe physical activity restrictions may reduce functional capacity and quality of life in post-AD patients and thus be harmful, underscoring the importance of further exploring the role of physical activity and/or structured exercise in this at-risk patient population.

Chronobiology of acute aortic rupture or dissection: A systematic review and a meta-analysis of the literature

Abstract: Objectives: Identification and quantification higher risk incidence of aortic rupture or dissection (AARD) could be of clinical interest and improve preventive strategies.Background: Several studies and subsequent meta-analyses have shown chronobiologic variations in the timing of occurrence of myocardial infarction, stroke, and pulmonary embolism. Conversely, such evidences are currently lacking for AARD despite a number of studies available dealing with periodicity.Methods: MEDLINE, EMBASE, and Google Scholar databases were searched up to July 2013. Temporal variation in the incidence of AARD was analyzed including all studies analyzing seasonal, monthly, weekly, and circadian aggregations. Two authors independently reviewed and extracted data.Results: Forty-two studies for a total of more than 80 000 patients were included. Our results showed a significantly increased incidence of AARD in Winter (Chi-square 854.92, p < 0.001), with a relative risk (RR) of 1.171 (99% CI 1.169, 1.172), in December (Chi-s...

Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis

Abstract: Aim Explore the relation between body mass index (BMI) and cardiovascular disease, and the influence of optimal medical therapy (OMT) on this relationship Methods and results Patients from the REACH cohort, an international, prospective cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders, including treatments and risk factors, were followed up to 4 years ( n = 54 285) Patients were categorized according to baseline BMI (ranging from underweight to Grade III obesity) Optimal medical therapy was defined as the use of the four cardioprotective medication classes (statins, ACE inhibitors/angiotensin II receptor blockers, β-blockers, and antiplatelet agents) The main outcomes were all-cause mortality, cardiovascular (CV) mortality, and CV events In primary and secondary prevention, a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes In secondary prevention, the highest adjusted risks were observed for underweight patients (197, P < 001, and 129, P = 003, for CV mortality and CV events) and the lowest HRs were observed, respectively, in Grade II and Grade III obese patients (073, P < 001 and 080, P < 001) The proportion of patients on OMT increased with BMI from 101 to 36% ( P < 0001) The apparent CV protection conferred by obesity persisted in patients receiving OMT Conclusion An obesity paradox was observed in both primary and secondary CV prevention patients The intensity of use of evidence-based preventive medications does not account for the paradoxical CV protection associated with obesity At extremes of BMI, further interventions beyond OMT may be needed to reduce CV risk

Omega-3 Fatty Acids and Heart Health

Abstract: Lifestyle intervention such as consistent aerobic exercise and a diet high in fruits and vegetables promotes cardiovascular health. A heart-healthy lifestyle decreases the risk of coronary heart disease and heart attack. Although it may seem intuitive that dietary fat is bad for the heart and that it must be avoided, certain unsaturated fats are heart healthy, and other saturated fats are not good for the heart. These heart-healthy unsaturated fats are known as omega-3 fatty acids. The 3 main omega-3 fatty acids that are beneficial for cardiovascular health are α-linoleic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is primarily found in plant-based foods such as olive, soybean, canola, walnut, and flaxseed oils, and in walnuts and flaxseeds, as well. EPA and DHA are primarily found in marine-based foods that include the variety of fatty fish, such as tuna, salmon, mackerel, herring, trout, halibut, and cod. This Cardiology Patient Page will present the beneficial effects of omega-3 fatty acids …

Sustained Benefit Over Four-Year Follow-Up of Michigan's Project Healthy Schools.

Abstract: OBJECTIVES: We determined the sustainability of effects of a school-based intervention to improve health behaviors and cardiovascular risk factors among middle school children. METHODS: We administered a questionnaire and health screenings to 5 schools in Ann Arbor and 2 schools in Ypsilanti, Michigan. We assessed demographics, physiological factors, diet, physical activity, and sedentary behaviors from 1126 students who received a health curriculum (Project Healthy Schools) in the fall of sixth grade in 2005, 2006, and 2007. We administered the questionnaire and screening again in the spring and each subsequent spring through ninth grade to all available, consenting students. RESULTS: In the 4 years following the school-based intervention, total cholesterol, low-density lipoprotein cholesterol, and triglycerides improved, and for most years systolic and diastolic blood pressure improved. Serum glucose and body mass index did not change. Physical activity increased and sedentary behaviors diminished. CONCLUSIONS: Project Healthy Schools is associated with sustainable improvements in both cardiovascular parameters and healthy behaviors. (Am J Public Health. Published online ahead of print October 15, 2015: e1-e7. doi:10.2105/AJPH.2015.302835). Language: en

Quality improvement in acute coronary syndromes: translating evidence into practice.

Abstract: Despite the substantial progress in elucidating the pathophysiology of acute coronary syndromes (ACS) and developing an array of therapeutic advances for the management of these conditions, several challenges still persist. The use of guideline recommendations for the care of patients with ACS by both healthcare providers and hospitals can improve short-term and long-term outcomes and potentially reduce healthcare costs. However, evidence suggests that adherence to guidelines is suboptimal. Several quality improvement programs, by both governmental and nongovernmental organizations, have been developed in an attempt to encourage maximal utilization of evidence-based interventions. In this review, we will examine the evidence for the importance of guideline adherence in the management of ACS, explore predictors of adherence to these guidelines, and provide evidence-based strategies for improving their implementation.

Project My Heart Your Heart: An Idea Whose Time Has Come

Abstract: It is estimated that nearly 1 million patients in low-income countries die every year from bradyarrhythmias coupled with no access to a pacemaker At the same time, it is estimated that tens of thousands of used devices could be harvested from hospitals, funeral homes, and crematories in wealthy nations if such a practice was legal and proven to be safe and efficacious Project My Heart Your Heart is a collaborative, multinational effort with a goal of making pacemaker recycling a reality Since its inception 4 years ago, the project has studied beliefs and attitudes of this idea among patients, pacemaker recipients, funeral home directors, and arrhythmia specialists The project has explored the safety and efficacy of this practice in several small pilot studies Nearly 15,000 used devices have been received and evaluated Efforts to fully define optimal methods for sterilization and device processing have progressed positively Safe, effective pacemaker recycling is possible and is generally supported by the public, patients, and cardiovascular specialists An ongoing dialogue with the FDA will hopefully lead to a large pivotal study in five countries which will definitively establish this practice including optimal strategies for device removal, interrogation, sterilization, handling, implantation, and follow-up at charitable pacemaker facilities servicing low income patients throughout the world

Perioperative cardiovascular care for patients undergoing noncardiac surgical intervention

Abstract: The field of perioperative medicine has garnered legitimacy during the past 3 decades. Adverse cardiovascular events in the perioperative period account for significant morbidity and mortality. Although testing patients preoperatively to detect ischemia and identify those who may benefit from modifications in care is a tempting strategy, risk assessment should account for posterior probability. Validated risk stratification tools, such as the Revised Cardiac Risk Index or the National Surgical Quality Improvement Program risk calculator, can assist in the identification of patients for whom preoperative noninvasive testing is justified and may change the plan of care. Furthermore, current guidelines emphasize that prophylactic coronary revascularization should not be performed exclusively for the purposes of reducing the risk of perioperative events. There has been enthusiasm for medical therapies that may reduce the risk of adverse cardiovascular events in the perioperative period. Current guidelines encourage the perioperative use of β-blockade in patients already receiving such therapy and caution against initiating such therapy on the day of the surgical procedure. Reduction of morbidity and mortality in the perioperative period relies on an understanding of the myriad physiological perturbations in this period and thoughtful selection of patients for further testing and treatment.

Abstract 12308: Aortic Aneurysm Associated With Bicuspid Aortic Valve: Relation to Gender, Hemodynamics, and Valve Morphology: The NHLBI GenTAC Registry

Abstract: Background: Aortic aneurysm phenotype in bicuspid aortic valve (BAV) may vary according to gender, hemodynamic alterations, and valve morphology (type of cusp fusion). To better understand these po...

Coronary computed tomographic angiography for preoperative risk: improved area under curve is not enough.

Abstract: The past several years have been a tumultuous and humbling time for those of us who manage and study perioperative patients. Not long ago, preoperative cardiac testing was almost routine, and large numbers of patients were treated with prophylactic coronary revascularization and β-blockers. However, few fields in medicine have experienced the seismic shifts seen in recommendations surrounding perioperative care, as recent randomized trials and registry studies1 have prompted us to be far more cautious in thinking about how and when to test and treat preoperative patients. See Article by Hwang et al In this issue of Circulation: Cardiovascular Imaging , Hwang et al2 examined 844 consecutive patients referred for coronary computed tomographic angiography (CTA) to screen for coronary artery disease before noncardiac surgery. Included patients had >1 cardiovascular risk factor or used cardiovascular medications, whereas patients with contraindications to computed tomography or previous coronary revascularization were excluded. A clinical score, the revised cardiac risk index, was compared with the revised cardiac risk index plus coronary CTA for prediction of perioperative major cardiac events, defined as cardiac death, myocardial infarction, or pulmonary edema within 30 days. Events occurred in 25 patients (3.0%), with mortality in only 9 patients (1.0%). On receiver–operator curve analysis, the presence of significant coronary artery disease on CTA as measured …

Noncardiac surgery ≤ 2 y after coronary stent placement was linked to perioperative MI and all-cause mortality

Abstract: Source Citation Holcomb CN, Graham LA, Richman JS, et al. The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting. J Am Coll Cardiol. 2014;64:2730-9. 25541124

Abstract MP65: High Mobile Device Usage Associated With Sedentary Behaviors and Less Physical Activity in 6th Grade Students

Abstract: Background: Sedentary screen time (including TV, computer and video games) has been correlated with childhood obesity and other health risks. The American Academy of Pediatrics (AAP) recommends that children limit their daily screen time to two hours in order to reduce the associated risk. Mobile device use has become increasingly popular amongst children and adolescents. However, mobile screen time (cell phone and tablet use) and its effect on physical activity in adolescents has yet to be thoroughly researched. Methods: Self-reported survey data were collected from 2,566 6th grade students enrolled in Project Healthy Schools during the 2013-2014 school year. Based on AAP guidelines, we split our sample into low mobile device users (≤2 hours/day) and high mobile device users (>2 hours/day). We compared physical activity, sports team participation and screen time habits between groups. Results: 20.73% (n=532) of the 6th graders surveyed reported being high mobile device users. 60.5% (n=322) of these were ...