Homeyar Dinshaw

Reduction in QT dispersion with rheolytic thrombectomy in acute myocardial infarction: evidence of electrial stability with reperfusion therapy.

An increase in QT dispersion (QTd) is associated with myocardial ischemia and may serve as a marker of ischemia and ventricular arrhythmia. We studied the effect of early reperfusion with rheolytic thrombectomy using an angiojet catheter (Possis, Minneapolis, MN) on QTd in 12 patients who presented with acute myocardial infarction. QTd and QT dispersion, rate‐corrected for RR interval, were significantly reduced from 57 ± 16 and 68 ± 13 msec before reperfusion to 34 ± 16 and 44 ± 19 msec after reperfusion respectively (mean ± SD; P < 0.002 and P < 0.0008, respectively). Successful reperfusion with rheolytic thrombectomy reduces QTd and may confer electrical stability to vulnerable myocardium. Reduction in indexes of repolarization inhomogeneity with reperfusion may serve as a noninvasive marker of coronary patency.

Development and Implementation of a Quality Improvement Process for Echocardiographic Laboratory Accreditation

We describe our process for quality improvement (QI) for a 3‐year accreditation cycle in echocardiography by the Intersocietal Accreditation Commission (IAC) for a large group practice. Echocardiographic laboratory accreditation by the IAC was introduced in 1996, which is not required but could impact reimbursement. To ensure high‐quality patient care and community recognition as a facility committed to providing high‐quality echocardiographic services, we applied for IAC accreditation in 2010. Currently, there is little published data regarding the IAC process to meet echocardiography standards. We describe our approach for developing a multicampus QI process for echocardiographic laboratory accreditation during the 3‐year cycle of accreditation by the IAC. We developed a quarterly review assessing (1) the variability of the interpretations, (2) the quality of the examinations, (3) a correlation of echocardiographic studies with other imaging modalities, (4) the timely completion of reports, (5) procedure volume, (6) maintenance of Continuing Medical Education credits by faculty, and (7) meeting Appropriate Use Criteria. We developed and implemented a multicampus process for QI during the 3‐year accreditation cycle by the IAC for Echocardiography. We documented both the process and the achievement of those metrics by the Echocardiography Laboratories at the Ochsner Medical Institutions. We found the QI process using IAC standards to be a continuous educational experience for our Echocardiography Laboratory physicians and staff. We offer our process as an example and guide for other echocardiography laboratories who wish to apply for such accreditation or reaccreditation.

Cardiac Rehabilitation and Exercise Training in the Elderly

Purpose of ReviewWith recent improvements in cardiovascular care and prevention, the demographic of individuals enrolled into cardiac rehabilitation (CR) is shifting towards an older set of individuals. Management plans for elderly cardiovascular patients must consider processes associated with aging, sarcopenia, cognitive impairment, and inflammation all contributing to declining functional capacity.Recent FindingsIncreased debility at baseline does not translate into a significantly higher risk associated with physical activity but does require better access. High-intensity interval training protocols have shown benefits while preserving safety over the standard of moderate-intensity continuous training.SummaryIn elderly populations, CR needs to include more than just exercise; addressing psychosocial stress burdens as an independent part of CR has the potential to improve adherence and outcomes. Doing this through new programs and at home and through mobile devices has the potential to greatly increase adherence and access, and can help remedy current underutilization of CR in the US medical system.