Aleksandr Rovner

Identification of Older Patients with Heart Failure Who May Be Candidates for Hospice Care: Development of a Simple Four‐Item Risk Score

OBJECTIVES: To identify predictors of 6‐month mortality in older patients with heart failure (HF) and to develop a risk score for identifying potential candidates for hospice care.

Possible Paradoxical Embolism as a Rare Cause for an Acute Myocardial Infarction

Paradoxical embolus is a rare entity and it has been incriminated as a cause of both cryptogenic strokes and myocardial infarctions (MI). Herein, we present a case of a patient diagnosed with a pulmonary embolism 1 week prior who now presented with an acute MI. Subsequent evaluation revealed a patent foramen ovale and a large thrombus in the right pulmonary artery. It was presumed that the etiology of her infarct was due to paradoxical embolus. The management of the patient is discussed and the literature is reviewed.

Role of Tissue Doppler and Color M‐Mode Imaging for Evaluation of Diastolic Function in Ambulatory Patients with LV Systolic Dysfunction

Introduction: Tissue Doppler imaging (TDI) and color M‐mode (CMM) indices provide assessment of left ventricular (LV) relaxation when combined with pulse‐wave Doppler (PWD)‐derived transmitral inflow, allows for estimation of LV filling pressures. However, use of these indices in patients with LV systolic dysfunction (LVSD) has not been well characterized. Methods and Results: The study included 115 patients (age 58 ± 11 years, 67% male) with LVSD (LV ejection fraction [LVEF] < 55%). Patients were grouped according to the diastolic LV filling pressure assessed by E/Emseptal ratio as follows: 1) Normal (NFP), E/Emseptal < 8; 2) Intermediate (IFP), E/Emseptal: 8–15; and 3) High (HFP), E/Emseptal >15. Age‐, gender‐, and LVEF‐adjusted analyses were performed. LV volumes and LVEF were significantly different between the groups (P < 0.01). PWD‐derived E‐wave velocity showed a significant stepwise increase across the three groups and the Emseptal velocity demonstrated a stepwise decrease (P < 0.01 for both). CMM‐derived diastolic intra‐ventricular pressure gradient (IVPG) was significantly lower in the HFP compared to the other 2 groups (P < 0.01 for both); Vp was increased in the HFP compared to the other 2 groups (P < 0.01 for both), and Vp exhibited a U‐shape relationship to LVEF. Conclusion: In patients with LVSD, abnormal LV relaxation is uniformly observed regardless of LV filling pressure. PWD‐derived E‐wave velocity and the TDI‐derived Em velocity are important measurements to identify elevated LV filling pressures. CMM‐derived Vp and IVPG were of limited incremental value for the evaluation of diastolic function in patients with LVSD.