Kim A. Eagle

Bio: Kim A. Eagle is an academic researcher from University of Michigan. The author has contributed to research in topics: Aortic dissection & Myocardial infarction. The author has an hindex of 129, co-authored 823 publications receiving 75160 citations. Previous affiliations of Kim A. Eagle include University of Wisconsin Hospital and Clinics & Spaulding Rehabilitation Hospital.

Prognostic value of elevated biomarkers in diabetic and non-diabetic patients admitted for acute coronary syndromes

Abstract: Diabetes is not only a predisposing factor for cardiovascular disease but once diabetic patients develop coronary artery disease (CAD) they have significantly worse outcomes compared to non-diabetic patients.1,2 Diabetes is an independent risk factor for a worse outcome after presentation with acute coronary syndrome (ACS).2 Prior studies have demonstrated that diabetic patients without previous myocardial infarction have as high a risk as non-diabetic patients with previous myocardial infarction.3 Based on this and other studies, diabetes is considered a CAD equivalent or, in other words, patients with diabetes should be treated as already having vascular disease. Elevated cardiac enzymes, both creatine kinase myocardial band (CK-MB) and troponin, have been demonstrated to be important prognostic determinants of patients with ACS and to identify high risk patients.4 The prognostic implications of elevated biomarkers in diabetic patients who are already considered to be at high risk have not been systematically studied. The primary objective was to analyse the prognostic implication of elevated biomarkers in patients with and without diabetes in predicting six month mortality. We studied 1951 consecutive patients who were admitted to the University of Michigan Medical Center from 27 December 1998 to 16 October 2002 with a diagnosis of ACS. The protocol was approved by the institutional review board at the University of Michigan and informed consent obtained from all patients. …

Dobutamine stress echocardiography. Stressing the indications for preoperative testing.

Abstract: In the current issue of Circulation, Poldermans et al1 report on the long-term prognostic value of dobutamine stress echocardiography in patients undergoing major vascular surgery. Their findings add to the growing literature on the use of exercise and dobutamine stress echocardiography as adjuncts in the assessment of prognosis among patients with known or suspected coronary artery disease. To date, the published experience with dobutamine stress echocardiography for assessment of prognosis and perioperative risk is relatively small compared with that using nuclear perfusion imaging techniques. Stress echocardiography is a more recently developed technique to detect coronary artery disease and myocardial ischemia, and all studies related to prognosis have been published since 1991. However, stress echocardiography is of increasing importance because of the increasing availability these techniques and because ofseveral advantages it offers over nuclear perfusion imaging. In addition to providing apparently equivalent data with respect to the presence and extent of coronary artery disease and myocardium at risk, dobutamine stress echocardiography allows assessment of valvular anatomy and function as well as resting and stress ventricular systolic function. This allows a more complete assessment of overall cardiac function, pertinent especially among patients with a history of congestive heart failure or cardiac murmur. Finally, stress echocardiographic techniques appear to have lower associated costs than the equivalent nuclear perfusion imaging counterparts, which may become increasingly important as the healthcare environment requires the delivery of cost-effective medical care. Poldermans et al2 and others3 4 have previously published reports on the utility of dobutamine stress echocardiography in the assessment of prognosis in a general population4 and for the identification of patients at increased perioperative risk during major vascular surgery.2 3 The report in the current issue of Circulation is important in that it describes the long-term prognostic data afforded by preoperative …

Mapping geographic areas of high and low drug adherence in patients prescribed continuing treatment for acute coronary syndrome after discharge.

Abstract: Study Objective. To determine the feasibility of using geographic information system (GIS) technology to identify geographic areas of high and low adherence to cardiovascular drug therapy for treatment of acute coronary syndrome (ACS) in patients discharged from a university-affiliated hospital. Design. Retrospective analysis. Data Source. A registry of patients admitted to and discharged from a large university-affiliated medical center for the treatment of ACS . Patients. A total of 1081 adults distributed over 300 census tracts who were discharged between April 1999 and December 2004 with a diagnosis of an ACS event of unstable angina or acute myocardial infarction. Measurements and Main Results. Data were collected on patient demographics, home addresses, and adherence to four classes of drugs—statins, angiotensin-converting enzyme inhibitors, -blockers, and aspirin—at 6–12 months after discharge for the ACS index event. A GIS program was used to map patient addresses and adherence data to geographic coordinates. Hot Spot Analysis was used to determine the existence of any spatial clustering patterns in adherence rates. The analysis was performed at the census tract level by using the percentage of nonadherent patients within a census tract to represent adherence for the people living within that tract, standardized by the number of residents in a census tract aged 40 years or older. Hot Spot Analysis identified unique geographic areas of high, neutral, and low adherence in the southeast area. Highly adherent census tracts were primarily located in and around the city where the university hospital and clinics are located. Areas of low adherence were located to the west, southwest, and southeast of the city. All other census tracts were considered neutral in adherence rates. Conclusion. Mapping geographic areas of drug adherence is feasible with use of GIS technology, with spatial mapping able to detect areas of varying levels of adherence. Future research should examine local-level factors associated with low adherence, which can be used to derive tailored, locally relevant interventions to improve long-term drug adherence.

Worldwide pacemaker and defibrillator reuse: Systematic review and meta-analysis of contemporary trials.

Abstract: Background Patients go without pacemaker, defibrillator, and cardiac resynchronization therapies (devices) each year due to the prohibitive costs of devices. Objective We sought to examine data available from studies regarding contemporary risks of reused devices in comparison with new devices. Methods We searched online indexing sites to identify recent studies. Peer-reviewed manuscripts reporting infection, malfunction, premature battery depletion, and device-related death with reused devices were included. The primary study outcome was the composite risk of infection, malfunction, premature battery depletion, and death. Secondary outcomes were the individual risks. Results Nine observational studies (published 2009-2017) were identified totaling 2,302 devices (2,017 pacemakers, 285 defibrillators). Five controlled trials were included in meta-analysis (2,114 devices; 1,258 new vs 856 reused). All device reuse protocols employed interrogation to confirm longevity and functionality, disinfectant therapy, and, usually, additional biocidal agents, packaging, and ethylene oxide gas sterilization. Demographic characteristics, indications for pacing, and median follow-up were similar. There were no device-related deaths reported and no statistically significant difference in risk between new versus reused devices for the primary outcome (2.23% vs 3.86% respectively, P = 0.807, odds ratio = 0.76). There were no significant differences seen in the secondary outcomes for the individual risks of infection, malfunction, and premature battery depletion. Conclusions Device reuse utilizing modern protocols did not significantly increase risk of infection, malfunction, premature battery depletion, or device-related death in observational studies. These data provide rationale for proceeding with a prospective multicenter noninferiority randomized control trial.

Effectiveness of implantable cardioverter-defibrillators in patients with ischemic heart disease and left ventricular dysfunction.

Abstract: Background Implantable cardioverter-defibrillators (ICDs) have been shown in primary prevention efficacy trials to reduce mortality in patients with ischemic heart disease and left ventricular dysfunction. To investigate the generalizabilty of this mortality reduction, we examined the effectiveness of ICDs in clinical practice. Methods We developed a prospective multicenter cohort of 770 patients with ischemic left ventricular dysfunction (ejection fraction ≤35%) and without a history of ventricular arrhythmia, of whom 395 (52%) received ICDs. Mean ± SD follow-up was 27 ± 12 months. We assessed the degree to which ICDs decreased mortality risk using Cox proportional hazards analyses that controlled for clinical predictors of death, receipt of ICD (a propensity score analysis), and predictors of arrhythmic death (including electrophysiologic variables). Results Multivariate Cox analyses showed that those with ICDs had significantly lower all-cause mortality (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.33-0.86). This mortality reduction was mediated through dramatically lower arrhythmia-related mortality (HR, 0.35; 95% CI, 0.17-0.73), with no significant effect on cardiovascular nonarrhythmic (HR, 0.81; 95% CI, 0.34-1.96) and noncardiovascular (HR, 0.76; 95% CI, 0.29-2.05) mortality. No differences were found between the ICD and non-ICD groups for a composite outcome of all-cause mortality, appropriate ICD shocks, or documented symptomatic ventricular arrhythmia, which suggests that the 2 groups had similar baseline risk for life-threatening arrhythmic events (HR, 0.96; 95% CI, 0.63-1.45). Conclusion In clinical practice, ICDs appear to reduce all-cause and arrhythmic rates of mortality at levels similar to those found in primary prevention trials.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Abstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Abstract: The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Abstract: PREAMBLE......e4 APPENDIX 1......e121 APPENDIX 2......e122 APPENDIX 3......e124 REFERENCES......e124 It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)

Abstract: Although considerable improvement has occurred in the process of care for patients with ST-elevation myocardial infarction (STEMI), room for improvement exists.[1–3][1][][2][][3] The purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients