Shishir Murarka

Progression of Paroxysmal to Persistent Atrial Fibrillation: Factors Promoting the HATCH Score*

With a lifetime 1 in 4 risk of its development ([1][1]), atrial fibrillation (AF) continues to be the most common cardiac arrhythmia that impairs quality of life and contributes to increased susceptibility to heart failure, hospitalization, stroke, and mortality, costing society more than

Review of Movahed’s sign (D shaped left ventricle seen on gated SPECT) suggestive of right ventricular overload

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Comparison of 30-Day Outcomes of Transfemoral Versus Transapical Approach for Transcatheter Aortic Valve Replacement: A Single-Center US Experience.

Recently, D shaped ventricle seen on gated SPECT imaging (Movahed’s sign) has shown to correlate with right ventricular overload similar to the D shape ventricle seen on echocardiography. Right ventricle (RV) imaging during gated SPECT studies is challenging because of the low tracer uptake due to relatively smaller right ventricular myocardial mass and lower coronary flow to the RV. Increased mass or workload causes higher tracer uptake in the RV wall secondary to increase in RV wall thickness and higher coronary flow. Furthermore, increased RV volume or pressure load can cause displacement of the septum towards the left ventricle causing septal flattening and a D shaped configuration of the left ventricular septum. This is an important finding that should be a part of nuclear gated SPECT interpretation.

Challenges in coronary CTO intervention after TAVR: a case report and discussion.

BACKGROUND The optimal access route for transcatheter aortic valve replacement (TAVR) remains debatable. We compared early safety outcomes at 30 days between the transfemoral (TF) and transapical (TA) approaches in a single, high-volume center in the United States. METHODS Data were collected retrospectively on consecutive patients who underwent TAVR by the TF or TA approach. The primary endpoints included the following: all-cause mortality; stroke; major and life threatening bleeding; renal failure; valve-related dysfunction requiring an intervention; and moderate to severe paravalvular leak and major vascular complications at 30 days. The secondary endpoints included need for a pacemaker and hospital length of stay. RESULTS A total of 123 well-matched patients underwent TAVR (TF 66 [54%] and TA 57 [46%]). All-cause mortality at 30 days was identical in both groups (TF 4.5% vs TA 5.3%, p = 0.999). The rates of myocardial infarction (TF 1.6% vs TA 1.5%, p = 0.999) and stroke (TF 3.0% vs TA 5.3%, p = 0.662) were similar. Major bleeding, acute renal failure, valve-related dysfunction, paravalvular leak, and mean hospital length of stay were also similar in both groups. Unplanned vascular complications, fluoroscopy time, and contrast utilization were significantly lower in the TA group. CONCLUSIONS The TA approach has similar early safety outcomes when compared with the TF approach. The TA approach is more procedurally efficient when compared with the TF approach.

Vitamins for cardiovascular diseases: is the expense justified?

Progression of coronary arteries after transcatheter aortic valve replacement is an important issue. Coronary revascularization in these patients can be challenging because of potential hindrance posed by the artificial valve structure in getting access to the coronary ostium. This gets even more difficult in chronic total occlusions (CTOs) that represent the most complex subset of coronary lesions. We report the first case of coronary CTO revascularization in a patient who underwent TAVR a few months prior and discuss the complexities involved in intervening such lesions.

TCT-623 Predictors of MACE with the WATCHMAN device: An Intention-to-Treat Analysis in a Real World Experience

Despite the knowledge that a well-balanced diet provides most of the nutritional requirements, the use of supplemental vitamins is widespread among adults in the United States. Evidence from large randomized controlled trials over the last 2 decades does not support vitamin supplementation for the reduction of cardiovascular risk factors or clinical outcomes. Many of the vitamins used in common practice likely are safe when consumed in small doses, but long-term consumption of megadoses is not only expensive but has the potential to cause adverse effects. Therefore, a need exists to revisit this issue, reminding the public and healthcare providers about the data supporting the use of vitamins for cardiovascular disease, and the potential for harm and the expense associated with their unnecessary use. In this review, we highlight the scientific evidence from randomized controlled studies regarding the efficacy and safety of vitamin supplementation for primary and secondary prevention of cardiovascular diseases and outcomes. We also draw attention to issues related to widespread and indiscriminate use of vitamin supplements and the need to educate the public to curtail unnecessary consumption and expense by limiting their use based on strong scientific evidence.

Correlation between estimated ejection fraction measured by echocardiography with ejection fraction estimated by cardiac catheterization in patients awaiting cardiac transplantation.

nos: 626 646 TCT-626 Validating a prediction modeling tool for LVOT obstruction after transcatheter mitral valve replacement Dee Dee Wang, Marvin Eng, Adam Greenbaum, Mayra Guerrero, William O’Neill