Haroon Yousaf

Association between alcohol consumption and systolic ventricular function: A population-based study

BACKGROUND Although moderate alcohol consumption is associated with decreased clinical heart failure, there are no population-based studies evaluating the relationship between alcohol consumption and left ventricular (LV) systolic function. We sought to evaluate the relationship between alcohol consumption and LV systolic function in the community. METHODS In a population-based random sample of 2,042 adults, age ≥45 years, we assessed alcohol consumption by a self-administered questionnaire. Responders were categorized by alcohol consumption level: abstainer, former drinker, light drinker (<1 drink a day), moderate drinker (1-2 drinks a day), and heavy drinker (>2 drinks a day). Systolic function was assessed by echocardiography. RESULTS We identified 38 cases of systolic dysfunction in 182 abstainers, 309 former drinkers, 1,028 light drinkers, 251 moderate drinkers, and 146 heavy drinkers. A U-shaped relationship was observed between alcohol consumption and moderate systolic dysfunction (LV ejection fraction [LVEF] ≤40%), with the lowest prevalence in light drinkers (0.9%) compared to the highest prevalence in heavy drinkers (5.5%) (odds ratio 0.14, 95% CI 0.04-0.43). This association persisted across different strata of risk factors of systolic dysfunction as well as in multivariate analysis. No significant association between alcohol consumption and systolic function was seen in subjects with LVEF >50% or ≤50%. CONCLUSIONS There is a U-shaped relationship between alcohol consumption volume and LVEF, with the lowest risk of moderate LV dysfunction (LVEF ≤40%) observed in light drinkers (<1 drink a day). These findings are parallel to the relationship between alcohol consumption and cardiovascular disease prevalence.

Traumatic pulmonary valve injury following blunt chest trauma

A 23-year-old man presented with exertional dyspnoea that had worsened over the past few years after sustaining chest contusions during a traffic accident. Auscultation over the pulmonary area revealed grade IV/VI diastolic murmur. Transthoracic echocardiography demonstrated a flail …

Multivariate Criteria Most Accurately Distinguish Cardiac from Noncardiac Causes of Dyspnea

Cardiopulmonary exercise testing provides oxygen pulse as a continuous measure of stroke volume, which is superior to other stress-testing methods in which systolic function is measured at baseline and at peak stress. However, the optimal peak oxygen pulse criterion for distinguishing cardiac from noncardiac causes of exercise limitation is unknown. In comparing several peak oxygen pulse criteria against the clinical standard of cardiopulmonary exercise testing, we retrospectively studied 54 consecutive patients referred for cardiopulmonary exercise testing. These exercise tests included measurement of oxygen consumption, carbon dioxide production, breathing reserve, arterial blood gases at baseline and at peak stress, exercise electrocardiogram, heart rate, and blood pressure response. Results were blindly interpreted and patients were categorized as members either of our Cardiac Group (abnormal result secondary to cardiac causes of exercise limitation) or of our Noncardiac Group (normal or abnormal result secondary to any noncardiac cause of exercise limitation). The accuracy of the peak oxygen pulse criteria ranged from 50% for univariate criterion (≤15 mL/beat), to 61% for oxygen pulse curve pattern, to 63% for bivariate criterion (≤15 mL/beat for men, ≤10 mL/beat for women), to as high as 81% for a multivariate criterion. All multivariate criteria outperformed oxygen pulse curve pattern, univariate, and bivariate criteria. This is the first study to evaluate the optimal peak oxygen pulse criterion for differentiating cardiac from noncardiac causes of exercise limitation. Multivariate criteria (especially a criterion incorporating age, sex, height, and weight) should be used preferentially, as opposed to the commonly used univariate and bivariate criteria.

PREVALENCE OF ERRORS IN FRACTIONAL FLOW RESERVE MEASUREMENT IN A HIGH VOLUME TERTIARY CARE CENTER

methods: We retrospectively evaluated all the clinically documented FFR measurements performed in the coronary catheterization laboratory over the last 4 years. Each pressure tracing was visually inspected for presence of artifacts by three physicians and then controversial tracings or those with artifacts were adjudicated by a committee of five physicians, led by the director of coronary catheterization laboratory. Then manual FFR measurement was performed on all the tracings. The procedure logs and medical records were obtained and any discrepancy between the clinically documented FFR and the manual FFR measurement was adjudicated by the same committee.

CORONARY AORTA DIASTOLIC PRESSURE INDEX: A NEW NOVEL INDICATOR FOR PREDICTING SIGNIFICANT CORONARY STENOSIS. A VALIDATION AGAINST FRACTIONAL FLOW RESERVE

Prior studies have evaluated baseline Pd/Pa (mean coronary artery/mean aorta pressure) ratio as well as iFR (instantaneous wave-free ratio obtained during entire period of diastole) to predict fractional flow reserve (FFR) ≤0.8. Since most of the flow occurs during diastole, we hypothesized a

VALIDATION OF A DIAGNOSTIC ALGORITHM FOR CARDIOPULMONARY EXERCISE TESTING: USEFULNESS IN CLINICAL CARDIOLOGY

Only cardiopulmonary exercise (CPX) testing provides information on the ability of the cardiovascular system to meet the bodys metabolic demands in terms of oxygen consumption (VO2) and carbon dioxide production (VCO2). However, CPX testing is underutilized by cardiologists due to complex

OPERATING TEST CHARACTERISTICS OF PEAK OXYGEN PULSE COMBINED WITH OXYGEN PULSE CURVE PATTERN IN DIAGNOSIS OF CARDIAC VERSUS NONCARDIAC CAUSES OF DYSPNEA

Cardiopulmonary exercise testing (CPX) utilizes oxygen (O2) pulse as a surrogate for stroke volume. In patients with cardiac causes of dyspnea, peak O2 pulse, O2 pulse curve pattern or both can be abnormal. The operating test characteristics (OTC) of the composite criterion (combining peak O2 pulse