Kenneth Jutzy

Comparative Evaluation of Rate Modulated Dual Chamber and VVIR Pacing

JUTZY, R.V., ET AL.: Comparative Evaluation of Rate Modulated Dual Chamber and VVIR Pacing. While dual chamber pacing is considered superior to VVI pacing at rest, there is a continuing debate as to the relative benefit of AV synchrony versus rate increase with exercise. To evaluate this question and to correlate different methods of evaluation, 14 patients with DDDR pacemakers were studied using serial treadmill exercise test with a CAEP protocol. Patients were exercised in DDD, DDDR, and VVIR modes. Echo‐Doppler cardiac outputs were determined and pulmonary gas exchange was measured during exercise. There was a significant improvement in cardiac output with exercise in the DDDR versus VVIR modes, and in DDDR versus DDD modes in patients with chronotropic incompetence. There were small increases in exercise duration in DDDR versus VVIR modes, and small but consistent increases in VO, at all levels of exercise, though not statistically significant. In this group of patients, DDDR pacing was superior to VVIR pacing, and superior to DDD pacing when chronotropic incompetence was present.

Detection of left atrial thrombi by two-dimensional echocardiography and surgical correlation in 148 patients with mitral valve disease.

Abstract Left atria1 (LA) thrombus has long been recognized as a complication of rheumatic mitral valve disease.1–4 Until the development of 2-dimensional echocardiography, these thrombi were rarely diagnosed before surgery. There have been few published reports3,4 regarding the utility of 2-dimensional echocardiography in the detection of LA thrombi, and the sensitivity and specificity of 2-dimensional echocardiography in detecting them remain uncertain. We undertook a review of all adult patients undergoing mitral valve replacement during a 64-month period to determine (1) the sensitivity and specificity of 2-dimensional echocardiography in detecting LA thrombi; (2) the location and attachment of the thrombi, (3) whether LA thrombi can form in mitral valve disease other than rheumatic mitral stenosis; (4) the clinical features associated with the development of LA thrombi, that is, the presence of atria1 fibrillation and LA size; and (5) whether the presence of thrombus is associated with embolic events.

COMPARISON OF OUTCOMES IN PATIENTS UNDERGOING RENAL TRANSPLANTATION WITH IMPAIRED VERSUS NORMAL LEFT VENTRICULAR EJECTION FRACTION

End-stage renal disease and dialysis are associated with poor quality of life and long term outcomes. Renal transplantation improves long term mortality, quality of life, and leads to lower healthcare costs. However, patients with impaired left ventricular ejection fraction (LVEF) are less likely to

ISCHEMIC TIME AND RISK FACTORS ASSOCIATED WITH THE INCIDENCE OF CARDIOGENIC SHOCK IN PATIENTS PRESENTING WITH ST ELEVATION MYOCARDIAL INFARCTION

INTRODUCTION Cardiogenic shock (CS) is the number one predictor of mortality in patients with STelevation myocardial infarction (STEMI). Emergent evaluation and treatment including revascularization when indicated is recommended upon arrival to hospital. There is variation in time to presentation and total ischemic time in this patient population. We sought to evaluate the impact of ischemic time on incidence of CS and variables which may influence its presentation.

GLYCEMIC CONTROL IN INSULIN AND NON-INSULIN DEPENDENT DIABETIC PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION PREDICTS TIME TO PRESENTATION

Background: Worldwide, the annual number of people diagnosed with diabetes continues to increase. Classically, Diabetes Mellitus (DM) has been associated with silent or atypical initial symptoms and increased time to presentation in patients presenting with ST elevation myocardial infarction (STEMI

IMPACT OF DEMOGRAPHICS AND SOCIOECONOMIC STATUS ON MODE OF TRANSPORTATION AND TIME TO PRESENTATION IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION

Background: National guidelines recommend the utilization of a robust network for pre-hospital care of patients who experience chest pain and other relatable symptoms subsequently classified as ST elevation myocardial infarction (STEMI). Despite the widespread use of this network, little is known

Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort

Objective: Insurance status is a predictor of drug-eluting stent (DES) usage. Our study sought to determine the effect of hospital and sociodemographic characteristics on utilization of DES in nationwide inpatient discharges with uniform insurance (Medicare). Methods: We linked data from the 2011 to 2012 Medicare discharges, 2011 Medicare hospital referral region (HRR) report (racial composition of each HRR), American Hospital Association (number of beds, rural/urban location, public/private status, and academic affiliation of hospitals), and American Community Survey 2011 (median income using zip code). We analyzed diagnosis-related group (DRG) codes 249 (bare metal stent without complications), 246, and 247 (DES with and without complications, respectively). Univariate and multivariable logistic regression was conducted to determine odds ratios (OR) for utilization of DES. Results: There were 322,002 discharges with DRG codes 246 (54,279), 247 (209,365), and 249 (58,358) in our database. Higher odds of DES usage was observed in Hispanic dominant HRR(s) (OR: 1.37, 95% confidence interval [CI]: 1.33-1.42, P < 0.001) compared to Caucasian dominant HRR(s). DES utilization was similar in African-American and Caucasian dominant HRR (s). Higher odds of DES use was observed in median household income groups ≥

IMPACT OF AREA DEPRIVATION INDEX ON UTILIZATION OF INTRA-CORONARY STENTS IN 2011-2012 MEDICARE NATIONWIDE COHORT

20,001 (OR: 1.07, 95% CI: 1.01-1.13, P - 0.03). Lower DES usage was observed in hospitals with higher total stent volume (quartile 4 vs. quartile 1: OR: 0.66, 95% CI: 0.63-0.69, P < 0.001) and for-profit hospitals (OR: 0.88, 95% CI: 0.85-0.92, P < 0.001). Conclusions: Our study findings suggest that there are significant differences in DES utilization in a national cohort of individuals with uniform insurance.

NATIONWIDE AVERAGE MEDICARE REIMBURSEMENTS FOR INPATIENT INTRA-CORONARY STENT DISCHARGES AND AREA DEPRIVATION INDEX

Singh’s Area Deprivation Index (ADI) is a marker of neighborhood deprivation based on 17 coefficients. Bare metal (BMS) and drug eluting stent (DES) utilization varies based on physician/patient preference, clinical scenario and insurance status. Our study evaluates variation in stent use based on

Echocardiography's Role in Cardiogenic Shock After Acute Myocardial Infarction:

Inpatient Medicare reimbursement to hospitals is based on Diagnosis Related Group (DRG) rate. Singh’s Area deprivation Index (ADI) is a composite indicator of neighborhood deprivation based on 17 coefficients. We evaluate variation in Medicare reimbursement for coronary stents based on hospital