Michael Schloss

Maximal Instantaneous Mitral Valve Velocities Measured with a Digital Echocardiographic Tracking System

Analysis of the motion of various cardiac structures is attaining increasing clinical significance. By coupling a digital tracking system to a commercially available echocardiograph, continuous position and velocity data from selected intracardiac structures were obtained. This tracking system, which employs a dynamic range gate, has been designed to isolate and lock on to a selected target within the heart. Position of the target is calculated every 8 ms; velocity is obtained by determining the difference between consecutive positions. This system has been used to study mitral valve motion in 20 normal subjects. Maximal instantaneous velocities of the anterior leaflet of the mitral valve were recorded. These instantaneous velocities are to be distinguished from the average velocities obtained by manually measuring the slopes of the curve segments. This system demonstrates a new technique for obtaining more detailed information about the dynamic characteristics of selected cardiac structures.

Investigation of Motivational Interviewing and Prevention Consults to Achieve Cardiovascular Targets (IMPACT) trial.

Background: Patients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation. Methods: A prospective, randomized, pilot study was conducted in 400 patients undergoing a nonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies. Patients were randomized in a 1:1:1 fashion to usual care (UC; group A, n = 134), in‐hospital CV prevention consult (PC; group B, n = 130), or PC plus behavioral intervention program (telephone‐based motivational interviewing and optional tailored text messages) (group C, n = 133). The primary end point was the &Dgr; change in non–high‐density lipoprotein cholesterol (non–HDL‐C) from baseline to 6 month. Results: The mean age was 64.6 ± 10.8 years, 23.7% were female, and 31.5% were nonwhite. After 6 months, the absolute difference in non–HDL‐C for all participants was −19.8 mg/dL (95% CI −24.1 to −15.6, P < .001). There were no between‐group differences in the primary end point for the combined PC groups (B and C) versus UC, with a &Dgr; adjusted between group difference of −5.5 mg/dL (95% CI −13.1 to 2.1, P = .16). Patients in the PC groups were more likely to be on high‐intensity statins at 6 months (52.9% vs 38.1%, P = .01). After excluding participants with baseline non–HDL‐C <100 mg/dL (initial exclusion criterion), &Dgr; non–HDL‐C and &Dgr; low‐density lipoprotein cholesterol were improved in the PC groups compared to UC (non–HDL‐C −8.13 mg/dL [−16.00 to −0.27], P = .04; low‐density lipoprotein cholesterol −7.87mg/dL [−15.10 to −0.64], P = .03). Conclusions: Although non–HDL‐C reduction at 6 months following a nonurgent CV procedure was not significant in the overall cohort, an increased uptake in high‐potency statins may translate into improved long‐term health outcomes and cost reductions.