Bhaskar Purushottam

Can total cardiac calcium predict the coronary calcium score

BACKGROUND Mitral annular calcification (MAC) shares the same risk factors as atherosclerosis and is associated with coronary artery disease as well as cardiovascular events. However, sensitivity and positive predictive value are low. We hypothesized that a global echocardiographic calcium score would better predict coronary atherosclerotic burden, as assessed by coronary artery calcium score (CAC), than MAC alone. METHODS An echocardiographic score was devised to measure global cardiac calcification in a semi-quantitative manner; this included calcification in the aortic valve and root, the mitral valve and annulus, and the sub-mitral apparatus. This score, and a simplified version, were compared with a similar calcification score by CT scan, as well as the CAC. RESULTS There was a good correlation between the two global calcification scores; the echocardiographic score also correlated with CAC. Using CAC >400 as a measure of severe coronary atherosclerosis, an echocardiographic score ≥5 had a positive predictive value of 60%. Importantly, the simplified score performed equally well (≥3 had a positive predictive value of 62%). CONCLUSIONS Global cardiac calcification, assessed by CT scan or echocardiography, correlates with the extent of coronary calcium. A semi-quantitative calcium score can be easily applied during routine echocardiographic interpretation and can alert the reader to the possibility of severe coronary atherosclerosis.

Dyssynchrony in Obese Subjects without a History of Cardiac Disease Using Velocity Vector Imaging

BACKGROUND The aim of this study was to examine the occurrence of intra-left ventricular (LV) dyssynchrony in obese versus nonobese subjects without known cardiac disease using Velocity Vector Imaging (VVI). METHODS One hundred ninety consecutive subjects with no known cardiac disease had their echocardiograms analyzed using VVI after excluding subjects with QRS durations>120 msec or LV ejection fractions<55%. Study subjects were divided into two groups on the basis of body mass index: obese (>30 kg/m2) and nonobese (<30 kg/m2). RESULTS The final cohort included 136 subjects (74 obese; 32% women; mean age, 55±16 years). The occurrence of intra-LV dyssynchrony was higher in the obese group compared with the nonobese group. CONCLUSIONS There was an increased prevalence of intra-LV dyssynchrony in obese subjects, especially longitudinal and radial dyssynchrony. This dyssynchrony may signal a mechanism by which obesity predisposes to the development of heart failure.

Relation Between Common Allergic Symptoms and Coronary Heart Disease Among NHANES III Participants

We investigated whether there is an increased risk of coronary heart diseases (CHD) in those with common allergic symptoms using the NHANES III, which is a representative sample of the United States population in 1988 to 1994. CHD was defined by Rose questionnaire and history of heart attack. Allergic symptoms were categorized into no symptoms (NO), rhinoconjunctivitis without wheezing (RC), and wheezing (WZ) based on symptoms. Multivariate logistic regression was used to obtain odds ratios (ORs) of CHD. Eight thousand six hundred fifty-three nonpregnant subjects ≥20 years old with overnight fasting ≥8 hours were included. CHD was present in 5.9% of the population; 36.5% did not have allergic symptoms (NO), 45.9% had RC, and 17.6% had WZ. The prevalence of CHD was 3.9% in NO, 4.8% in RC, and 12.8% in WZ (p <0.001). Compared to NO, unadjusted ORs of CHD were 1.24 (95% confidence interval 0.94 to 1.62) in RC and 3.58 (2.68 to 4.78) in WZ and ORs adjusted for sociodemographic factors and co-morbidities were 1.40 (1.02 to 1.92) in RC and 2.64 (1.79 to 3.90) in WZ. Only the group of women <50 years of age had significantly increased ORs in RC and WZ. In conclusion, common allergic symptoms were significantly associated with an increased risk of CHD.

Significance of QRS duration in non-ST elevation myocardial infarction

Part of the Cardiology Commons This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson Universitys Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship.Significance of QRS duration in non-ST elevation myocardial infarction.

Effects of Pulmonary Hypertension on Kidney Function

There is a scarcity of data defining hemodynamic correlates of renal function in pulmonary hypertension (PH). The aim of this study was to assess the correlation between standard and novel hemodynamic indices, including the pulmonary artery pulsatility index (PAPi) and the right atrial to pulmonary capillary wedge pressure (RA:PCWP) ratio, and renal function in PH. We conducted a retrospective study of adult patients with PH diagnosed by right-heart catheterization (RHC) between January 2007 and October 2012 at Einstein Medical Center, Philadelphia. Patients with end-stage renal disease were excluded. Pulmonary artery pulse pressure, RA:PCWP, PAPi (pulmonary artery pulse pressure/RA), as well as standard RHC variables were studied. The final cohort consisted of 171 patients. The median age was 59±13 years, 52% were men, and the mean pulmonary arterial pressure was 39±8.9 mm Hg. Sixty-eight patients had worsening creatinine from the time of admission to the time of RHC. Patients with a RA:PCWP of >0.86 had a significantly higher creatinine level at RHC (2.2±1.0 vs. 1.7±1.7 mg/dL, P=0.01) and worsening creatinine (+0.9±0.9 vs. +0.4±0.3 mg/dL, P=0.03). The major finding of this study is that in PH (all groups), worsening renal function from the time of admission to RHC correlated significantly with high RA:PCWP and low ejection fraction. High RA:PCWP was found to be a better predictor of worsening renal function than other novel and standard hemodynamic indices such as elevated right atrial pressure and PAPi.

Toxic Effects of Alcohol on the Heart

Although alcohol has been imbibed by most civilizations throughout recorded history, its use has always been accompanied by calls for temperance. Globally, alcohol remains one of the leading contributors to morbidity and mortality, besides having pervasive psychosocial and economic consequences. Alcohol has a complex relationship with cardiovascular health and has often been equated to a razor-sharp double-edged sword. While light-to-moderate alcohol intake may have a protective effect on cardiovascular risk in certain populations, excessive or heavy episodic (binge) drinking has well-described harmful sequelae. Specific cardiovascular toxic effects include cardiomyopathy, cardiac arrhythmias, sudden cardiac death, hypertension, and stroke. This chapter presents a comprehensive review of the evidence behind the cardiovascular effects of alcohol and examines possible physiological mechanisms responsible for its noxious effects on the heart.

THE MAGNITUDE OF CARDIOVASCULAR CHANGE IN CIRRHOTIC CARDIOMYOPATHY IN PREDICTING OF HEPATORENAL SYNDROME

Cirrhotic cardiomyopathy describes a constellation of cardiovascular abnormalities that can be present in cirrhotic patients. There remains a scarcity of data studying the relationship between cirrhotic cardiomyopathy and hepatorenal syndrome (HRS). We sought to identify cardiovascular abnormalities

QRS duration predicts 30 day mortality following ST elevation myocardial infarction

Studies have demonstrated an association between QRS duration and long term mortality after myocardial infarction [1,2]. However, there remains a scarcity of data on QRS duration after ST elevation myocardial infarction (STEMI) and its association with mortality.We investigatedwhether QRS duration during STEMI hospitalization could predict 30-day and one yearmortality. A secondary objective was to determine the relationship between prolonged QRS and occurrence of inpatient ventricular arrhythmias. Five hundred and fifty three patients admitted to Einstein Medical Center, Philadelphia from August 1, 2006 to August 31, 2011 with a diagnosis of STEMI were screened. The study protocol was approved by our Institutional Review Board. The author(s) of this manuscript have certified that they comply with the principles of ethical publishing in the International Journal of Cardiology. STEMI was diagnosed on the basis of cardiac symptoms and electrocardiographic changes consisting of ST elevation in two contiguous leads in accordance with the guidelines [3]. Patients with any of the following were excluded:

Sudden Cardiac Death and Addictive Chemical Substances

Over the last century, an epidemic of substance abuse in the United Sates has resulted in significant mortality and morbidity. Drug abuse is now a major problem in many societies, though the pattern of drug abuse differs from country to country and even from one province to another. The most common illicit drugs abused worldwide include cannabis, cocaine, amphetamines, and opiates such as heroin. In this chapter, we discuss the role of addictive substances in sudden death.

Sudden Cardiac Death and Alcohol

Alcohol is a well-recognized risk factor for sudden death. Alcohol abuse may contribute to a significant proportion of non-coronary sudden deaths. There are several mechanisms through which alcohol abuse could increase sudden death risk, including increasing the QT interval, decreasing vagal input, sympathoadrenal stimulation, electrolyte abnormalities and cardiomyopathy. Ventricular arrhythmias are the most common mode of alcohol-related sudden death, including automaticity, triggering and re-entry mechanisms. Other less common causes of alcohol-related sudden death including intracranial bleeds, heart blocks, metabolic acidosis with cardiac standstill, and exsanguinating gastrointestinal bleed, should be borne in mind, when evaluating an alcoholic patient who has been resuscitated.