Publications by authors named "Anupama Kottam"

31 Publications

Non-invasive ischemic evaluation in an aging population of transposition of great arteries patients with atrial switch procedure.

J Nucl Cardiol 2022 Jan 10. Epub 2022 Jan 10.

Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA.

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http://dx.doi.org/10.1007/s12350-021-02900-7DOI Listing
January 2022

A Case of Mitral Annular Disjunction in Marfan Syndrome.

CASE (Phila) 2021 Aug 4;5(4):221-223. Epub 2021 May 4.

Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan.

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http://dx.doi.org/10.1016/j.case.2021.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370866PMC
August 2021

Rudimentary left atrial appendage in atrial fibrillation, congenital occlusion device, or continued thrombotic risk.

Eur Heart J Case Rep 2021 May 12;5(5):ytab177. Epub 2021 May 12.

Department of Cardiology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA.

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http://dx.doi.org/10.1093/ehjcr/ytab177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117425PMC
May 2021

Challenges of left atrial appendage closure device and anticoagulation in a patient with immune thrombocytopenia (ITP).

BMJ Case Rep 2021 Mar 25;14(3). Epub 2021 Mar 25.

Department of Cardiology, Wayne State University, Detroit, Michigan, USA.

Among patients with atrial fibrillation (AF) who have high risk of bleeding secondary to haematologic disorders, left atrial appendage (LAA) occlusion therapy has been shown to be an excellent alternative to long-term use of oral anticoagulation for thromboembolic stroke prevention. However, there remains a major concern of device-associated thrombosis post-procedure, that can lead to life-threatening embolic events. To this date, there is no systematic guideline for the selection and management of patients with haematological disorders with LAA occlusion therapy, especially in those with platelet disorders such as immune thrombocytopenia (ITP). Patients with platelet disorders are at a higher risk for bleeding; however, that does not prevent such patients from thromboembolic events secondary to AF. We present a case of ITP with permanent AF, where an LAA device was complicated by thrombus formation due to challenges faced with anticoagulation therapy.
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http://dx.doi.org/10.1136/bcr-2021-241985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006819PMC
March 2021

Late-Onset Bioprosthetic Mitral Valve Thrombosis Treated With Apixaban.

Circ Cardiovasc Imaging 2021 02 1;14(2):e011148. Epub 2021 Feb 1.

Division of Cardiology, Department of Medicine (J.D., A.S., A.K., L.A.), Wayne State University, Detroit, MI.

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http://dx.doi.org/10.1161/CIRCIMAGING.120.011148DOI Listing
February 2021

Atypical presentation of cardiac sarcoidosis: role of multimodality imaging and review of literature.

BMJ Case Rep 2020 Feb 10;13(2). Epub 2020 Feb 10.

Cardiology, Detroit Medical Center, Detroit, Michigan, USA.

Cardiac sarcoidosis (CS) is challenging to determine, consequently is under-recognised in clinical practice. The accurate prevalence of CS is possibly underestimated due to unspecific symptoms, subclinical illness and the dearth of universally accepted diagnostic criteria. Totally, non-invasive diagnosis of CS was proposed in 2015 by the Japanese Ministry of Health and Welfare using positron emission tomography and cardiac MRI findings as major criteria and substituting histological verification. We present a case of a 60-year-old woman with pulmonary sarcoidosis presenting with progressively worsening palpitations and recurrent syncope. Her initial evaluation at another hospital facility revealed normal cardiac testing. A detailed evaluation with echocardiography and cardiac MRI helped us arrive at the diagnosis of CS, which resulted in appropriate treatment and resolution of symptoms. We discuss CS in general, the clinical disease, diagnostic algorithms, latest guidelines and management.
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http://dx.doi.org/10.1136/bcr-2019-232047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021104PMC
February 2020

Early-Onset Bilateral Severe Valvular Regurgitation After Mediastinal Radiotherapy in Hodgkin Lymphoma Survivors: Should We Screen Prior to 10 Years After Mediastinal Radiotherapy?

Ochsner J 2019 ;19(3):252-255

Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI.

Radiation-induced valvulopathy (RIV) is a common complication of mediastinal radiotherapy and usually occurs at least 10 years after exposure to radiotherapy. We report the case of a 37-year-old female with a history of stage IIIB Hodgkin lymphoma who was diagnosed with RIV after all other potential causes of shortness of breath and valvular dysfunction were excluded. The patient's presentation, 6 years after receiving chemotherapy and radiotherapy for Hodgkin lymphoma, was earlier than expected after mediastinal radiotherapy. The patient was started on a regimen of lisinopril, nifedipine, and metoprolol, and her symptoms improved significantly within 4 days of starting medical therapy. We review the literature, discuss the risk factors and determinants of developing RIV, and suggest the ideal timing to screen patients. This case is of educational value for internal medicine, oncology, and cardiology healthcare providers who should consider RIV as a cause of shortness of breath in patients who underwent mediastinal radiotherapy for Hodgkin lymphoma.
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http://dx.doi.org/10.31486/toj.18.0063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735590PMC
January 2019

A Doppler Echocardiographic Pulmonary Flow Marker of Massive or Submassive Acute Pulmonary Embolus.

J Am Soc Echocardiogr 2019 07 2;32(7):799-806. Epub 2019 May 2.

Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Background: To date, echocardiography has not gained acceptance as an alternative imaging modality for the detection of massive pulmonary embolism (MPE) or submassive pulmonary embolism (SMPE). The objective of this study was to explore the clinical utility of early systolic notching (ESN) of the right ventricular outflow tract (RVOT) pulsed-wave Doppler envelope in the detection of MPE or SMPE.

Methods: Two hundred seventy-seven patients (mean age, 56 ± 16 years; 52% women), without known pulmonary hypertension, who underwent contrast computed tomographic angiography for suspected pulmonary embolism (PE) and underwent echocardiography were retrospectively studied. Extent of PE was categorized using standard criteria. ESN identified from pulsed-wave spectral Doppler interrogation of the RVOT was analyzed, as were other echocardiography parameters such as McConnell's sign, the "60/60" sign, and acceleration and deceleration times of the RVOT Doppler signal. Analysis was conducted using probability statistics and receiver operating characteristic curve analysis.

Results: Of the 277 patients studied, 100 (44%) had MPE or SMPE, 87 (38%) had subsegmental PE, and 90 (39%) did not have PE. ESN was observed in 92% of patients with MPE or SMPE, 2% with subsegmental PE, and in no patients without PE. Interobserver assessment of early systolic notching demonstrated 97% agreement (κ = 0.93, P < .001). Compared with more widely recognized echocardiographic parameters, the area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI, 0.92-0.98) for ESN was superior to that for McConnell's sign (AUC, 0.75; 95% CI, 0.68-0.80), the 60/60 sign (AUC, 0.74; 95% CI, 0.68-0.79), and RVOT acceleration time ≤ 87 msec (AUC, 0.84; 95% CI, 0.79-0.88), as well as other study Doppler variables, in patients with computed tomography-confirmed MPE or SMPE.

Conclusions: The pulmonary Doppler flow pattern of ESN appears to be a promising noninvasive sign observed frequently in patients with MPE or SMPE. Future prospective study to ascertain diagnostic utility in a broader population is warranted.
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http://dx.doi.org/10.1016/j.echo.2019.03.004DOI Listing
July 2019

Are serum troponin levels elevated in conditions other than acute coronary syndrome?

Cleve Clin J Med 2018 04;85(4):274-277

Division of Pulmonary, Critical Care, and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.

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http://dx.doi.org/10.3949/ccjm.85a.17011DOI Listing
April 2018

Echocardiography in Infective Endocarditis: State of the Art.

Curr Cardiol Rep 2017 10 25;19(12):127. Epub 2017 Oct 25.

Detroit Medical Center, Harper University Hospital, 3990 John R, 4 Hudson, Detroit, MI, 48201, USA.

Purpose Of Review: In this review, we examine the central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE).

Recent Findings: 2D transthoracic echocardiography (TTE) and transesophageal echocardiography TEE have complementary roles and are unequivocally the mainstay of diagnostic imaging in IE. The advent of 3D and multiplanar imaging have greatly enhanced the ability of the imager to evaluate cardiac structure and function. Technologic advances in 3D imaging allow for the reconstruction of realistic anatomic images that in turn have positively impacted IE-related surgical planning and intervention. CT and metabolic imaging appear to be emerging as promising ancillary diagnostic tools that could be deployed in select scenarios to circumvent some of the limitations of echocardiography. Our review summarizes the indispensable and central role of various echocardiographic modalities in the management of infective endocarditis. The complementary role of 2D TTE and TEE are discussed and areas where 3D TEE offers incremental value highlighted. An algorithm summarizing a contemporary approach to the workup of endocarditis is provided and major societal guidelines for timing of surgery are reviewed.
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http://dx.doi.org/10.1007/s11886-017-0928-9DOI Listing
October 2017

The challenges of treating recurrent polymorphic ventricular tachycardia due to coronary vasospasm: Lessons from an interesting case.

J Electrocardiol 2017 Nov - Dec;50(6):972-974. Epub 2017 Jul 12.

Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA. Electronic address:

Coronary artery vasospasm can cause recurrent anginal episodes with ST-segment elevation. Vasospasm induced myocardial ischemia can lead to arrhythmias including life threatening ventricular tachycardia (VT). Percutaneous coronary intervention (PCI), although not routinely recommended for treating vasospastic angina, can be considered for discrete coronary spasm that is not amenable to vasodilator therapy. We present a challenging case of a 41-year-old lady with recurrent episodes of vasospastic angina and VT refractory to medical therapy, which was successfully treated with PCI and an implantable cardioverter defibrillator.
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http://dx.doi.org/10.1016/j.jelectrocard.2017.07.003DOI Listing
August 2018

Extramedullary leukaemia presenting as cardiac myeloid sarcoma.

ANZ J Surg 2019 01 16;89(1-2):E41-E42. Epub 2017 May 16.

Department of Cardiology, Detroit Medical Center, Detroit, Michigan, USA.

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http://dx.doi.org/10.1111/ans.14036DOI Listing
January 2019

Ranolazine-Associated Myoclonus.

Am J Ther 2018 Jul/Aug;25(4):e507-e508

Division of the Cardiology, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI.

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http://dx.doi.org/10.1097/MJT.0000000000000598DOI Listing
March 2019

Right-sided endocarditis: eustachian valve and coronary sinus involvement.

Echocardiography 2017 Jan 22;34(1):143-144. Epub 2016 Aug 22.

Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA.

Infective endocarditis in patients with intravenous drug use commonly involves right-sided heart valves. Eustachian valve (EV) endocarditis is not commonly seen given the valve's infrequent presence. Involvement of the coronary sinus (CS) with endocarditis is also an unusual finding. We present a case with echocardiographic findings consistent with EV endocarditis along with CS involvement, which appropriately responded to antibiotics.
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http://dx.doi.org/10.1111/echo.13345DOI Listing
January 2017

Comparison of Left Ventricular Contractile Abnormalities in Stress-Induced Cardiomyopathy versus Obstructive Coronary Artery Disease Using Two-Dimensional Strain Imaging.

Echocardiography 2016 Jun 21;33(6):863-70. Epub 2016 Jan 21.

Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.

Background: Data on left ventricular (LV) strain profiles in patients with takotsubo cardiomyopathy (TC) in comparison with obstructive coronary artery disease (CAD) are limited. We sought to investigate regional and global LV longitudinal strain in a cohort of patients with known TC using two-dimensional strain imaging (2DS) in comparison with patients with acute cardiomyopathy (ACM) due to severe obstructive left anterior descending arterial disease or triple-vessel disease and healthy controls.

Methods: Transthoracic echocardiography was performed in 34 patients with established TC, 24 patients with ACM, and 30 healthy subjects. We measured the segmental longitudinal strain in apical views by the use of EchoInsight Epsilon software. Left ventricular global longitudinal strain (GLS) was calculated by averaging segmental wall strains.

Results: The TC and ACM groups were comparable for age and demographic characteristics. Systolic and diastolic function were significantly impaired in both groups compared to controls. LV global and segmental systolic strain was also significantly attenuated in patients with TC and ACM compared to controls (P < 0.001). Moreover, LV basal segmental longitudinal strain was higher in the patients with TC compared to ACM (P = 0.02). Global and apical segmental strain appear to be higher in patients with mid-ventricular variant compared to those with apical variant of TC with apical strain cutoff value of -7.85%, offering the best discriminatory value for differentiating these two patterns (P = 0.001).

Conclusions: The results of this hypothesis-generating study indicate that longitudinal LV strain parameters are similarly impaired in patients with TC and ACM due to severe obstructive left anterior descending arterial disease or triple-vessel disease. Assessment of two-dimensional LV strain parameters could help differentiate between different TC patterns.
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http://dx.doi.org/10.1111/echo.13178DOI Listing
June 2016

Comparison of right ventricular contractile abnormalities in hypertrophic cardiomyopathy versus hypertensive heart disease using two dimensional strain imaging: a cross-sectional study.

Int J Cardiovasc Imaging 2015 Dec 6;31(8):1503-9. Epub 2015 Aug 6.

Division of Cardiology, Harper University Hospital, Detroit Medical Center, Wayne State University, Detroit, MI, 48201, USA.

Hypertrophic cardiomyopathy (HCM) affects the right ventricle (RV) because of the anatomically hypertrophied septum and plausibly by extension of the myopathic process to the RV. We sought to investigate RV strain in patients with left ventricular hypertrophy secondary to either HCM or hypertension (H-LVH). Our cross-sectional study included 32 patients with HCM, 21 patients with H-LVH, and 11 healthy subjects, who were evaluated with transthoracic echocardiography. Using a dedicated software package, bi-dimensional acquisitions were analyzed to measure segmental longitudinal strain in apical views. Right ventricular global longitudinal strain (GLS) was calculated by averaging septal and right free wall strains. The HCM and H-LVH groups were comparable for age and demographic characteristics. Right ventricular tricuspid annular plane systolic excursion was not significantly different between HCM and H-LVH subjects. Moreover, RV GLS, septal and lateral RV myocardial strain were significantly impaired in patients with HCM (all p < 0.001). Regional and global RV strain parameters were not significantly impaired in H-LVH compared to healthy controls An RV GLS cut-off value of >14.9% differentiated HCM and H-LVH with a 90% sensitivity and a 95% specificity (p < 0.001). RV strain parameters are impaired in patients with HCM. Assessment of two-dimensional RV strain parameters could help differentiate between HCM and H-LVH.
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http://dx.doi.org/10.1007/s10554-015-0722-yDOI Listing
December 2015

Actinomycotic endocarditis of the eustachian valve: a rare case and a review of the literature.

Tex Heart Inst J 2015 Feb 1;42(1):44-9. Epub 2015 Feb 1.

Eustachian valve endocarditis caused by Actinomyces species is extremely rare. A literature review revealed only one reported case-caused by Actinomyces israelii in an intravenous drug abuser. Our patient, a 30-year-old woman who at first appeared to be in good health, presented with fever, a large mobile mass on the eustachian valve, and extensive intra-abdominal and pelvic masses that looked malignant. Histopathologic examination of tissue found in association with an intrauterine contraceptive device revealed filamentous, branching microorganisms consistent with Actinomyces turicensis. This patient was treated successfully with antibiotic agents. In addition to presenting a new case of a rare condition, we discuss cardiac actinomycotic infections in general and eustachian valve endocarditis in particular: its predisposing factors, clinical course, sequelae, and our approaches to its management.
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http://dx.doi.org/10.14503/THIJ-13-3517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378043PMC
February 2015

Novel oral anticoagulants in patients undergoing cardioversion for atrial fibrillation.

J Thromb Thrombolysis 2015 Aug;40(2):139-43

Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, IL, 48226, USA,

Recent trials on novel oral anticoagulants (NOAC) in patients undergoing cardioversion showed that NOACs are as safe and effective as treatment with vitamin K antagonists in patients with atrial fibrillation undergoing electric or pharmacological cardioversion. We conducted an EMBASE and MEDLINE search for studies in which patients undergoing cardioversion were assigned to treatment with NOACs versus VKAs. We identified one prospective randomized study and three post hoc analysis of randomized trials which enrolled 2,788 controls that received NOACs and 1,729 patients that received VKAs. NOACs and VKAs had comparable effects on the rates of stroke/thromboembolism, major bleeding events and all-cause mortality. NOACs are safe and effective alternatives to VKA in patients with AF undergoing cardioversion.
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http://dx.doi.org/10.1007/s11239-014-1161-7DOI Listing
August 2015

Association of cystatin C with measures of obesity and its impact on cardiovascular events among healthy US adults.

Metab Syndr Relat Disord 2014 Nov 14;12(9):472-6. Epub 2014 Aug 14.

1 Department of Cardiology, Wayne State University/Detroit Medical Center , Detroit, Michigan.

Background: This study sought to explore the relationship between cystatin C (CysC) and anthropometric measures of obesity and the influence of this association on mortality [cardiovascular disease (CVD), coronary heart disease, and all-cause] in a nationally representative population free of CVD, diabetes mellitus, and macroalbuminuria (MA).

Methods: The study cohort included 4577 adult participants of the Third National Health and Nutrition Examination Survey (NHANES). Spearman correlation analysis was performed to ascertain the association between various anthropometric measures and CysC. Formal statistical analyses of the interaction term between anthropometric measures and CysC for outcomes were performed followed by stratified multivariate Cox proportional hazard analyses.

Results: A moderate degree of association was seen between CysC and measures of visceral adiposity as represented by waist-to-height ratio (WHR) and waist circumference (WC) and only a weak association between CysC and body mass index (BMI). CysC was predictive of all study outcomes in individuals with normal anthropometric measurements only.

Conclusions: CysC correlated better with measures of visceral adiposity (WC and WHR) compared to BMI and appears to be a better predictor of adverse cardiovascular outcomes among those with anthropometric measures not suggestive of obesity compared to those with abnormal measures of anthropometry.
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http://dx.doi.org/10.1089/met.2014.0018DOI Listing
November 2014

Is bacteriostatic saline superior to normal saline as an echocardiographic contrast agent?

Int J Cardiovasc Imaging 2014 Dec 15;30(8):1483-9. Epub 2014 Jul 15.

Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Harper University Hospital, Wayne State University, 3990 John R, 8 Brush, Detroit, MI, 48201, USA.

Objective data on the performance characteristics and physical properties of commercially available saline formulations [normal saline (NS) vs. bacteriostatic normal saline (bNS)] are sparse. This study sought to compare the in vitro physical properties and in vivo characteristics of two commonly employed echocardiographic saline contrast agents in an attempt to assess superiority. Nineteen patients undergoing transesophageal echocardiograms were each administered agitated regular NS and bNS injections in random order and in a blinded manner according to a standardized protocol. Video time-intensity (TI) curves were constructed from a representative region of interest, placed paraseptally within the right atrium, in the bicaval view. TI curves were analyzed for maximal plateau acoustic intensity (Vmax, dB) and dwell time (DT, s), defined as time duration between onset of Vmax and decay of video intensity below clinically useful levels, reflecting the duration of homogenous opacification of the right atrium. To further characterize the physical properties of the bubbles in vitro, fixed aliquots of similarly agitated saline were injected into a glass well slide-cover slip assembly and examined using an optical microscope to determine bubble diameter in microns (µm) and concentration [bubble count/high power field (hpf)]. A higher acoustic intensity (a less negative dB level), higher bubble concentration and longer DT were considered properties of a superior contrast agent. For statistical analysis, a paired t test was conducted to evaluate the differences in means of Vmax and DT. Compared to NS, bNS administration was associated with superior opacification (video intensity -8.69 ± 4.7 vs. -10.46 ± 4.1 dB, P = 0.002), longer DT (17.3 ± 6.1 vs. 10.2 ± 3.7 s) in vivo and smaller mean bubble size (43.4 vs. 58.6 μm) and higher bubble concentration (1,002 vs. 298 bubble/hpf) in vitro. bNS provides higher intensity and more sustained opacification of the right atrium compared to NS. Higher bubble concentration and stability appear to be additional desirable rheological characteristics favoring bNS as a contrast agent.
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http://dx.doi.org/10.1007/s10554-014-0493-xDOI Listing
December 2014

Comparison of patients with peripartum heart failure and normal (≥55%) versus low (<45%) left ventricular ejection fractions.

Am J Cardiol 2014 Jul 2;114(2):290-3. Epub 2014 May 2.

Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan.

The current definition of peripartum cardiomyopathy (PC) is restricted to patients with left ventricular systolic dysfunction (ejection fraction [EF]<45%). Data on peripartum heart failure (HF) with normal EF are sparse. We describe clinical characteristics of patients with normal (≥55%) and patients with low (<45%) left ventricular ejection fractions (LVEFs). Electronic medical records (2006 to 2013) of our tertiary care center were retrospectively screened to identify peripartum HF with normal EF, defined as an entity meeting Framingham criteria for HF with symptom onset during the last month of pregnancy or up to 5 months after delivery and with an EF of ≥55%. Clinical characteristics, echocardiographic parameters, and outcomes of these patients were compared with age-matched control patients with traditionally defined PC (EF<45%). A total of 25 patients with PC and EF≥55% were identified. Exclusion of hypertension (n=9), preeclampsia (n=1), and diabetes mellitus (n=2) yielded 13 patients with PC and EF≥55%. Age-matched patients with traditional PC (EF<45%) constituted controls (n=16). Compared with patients with PC and low LVEF, patients with PC and normal LVEF had lower B-type natriuretic peptide levels, systolic and diastolic left ventricular dimensions, left atrial size, and incidence of decompensated HF during delivery (p<0.05). Compared with historical age-matched controls, patients with normal LVEF exhibited attenuated E' mitral annular velocities. On follow-up, these patients were associated with a lower New York Heart Association functional class. In conclusion, peripartum HF with normal LVEF appears to be a distinct entity.
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http://dx.doi.org/10.1016/j.amjcard.2014.04.037DOI Listing
July 2014

Uric acid and cardiovascular disease risk reclassification: findings from NHANES III.

Eur J Prev Cardiol 2015 Apr 15;22(4):513-8. Epub 2014 Jan 15.

Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, USA

Background: The studied associations between serum uric acid (sUA) and cardiovascular disease (CVD) events have been controversial. We sought to evaluate the association between sUA and CVD mortality, including its ability to reclassify risk in a multiethnic nationally representative population free of clinical CVD and diabetes at baseline.

Methods: The study cohort included 11,009 adults enrolled as a part of the National Health and Nutrition Examination Survey (NHANES) III. Multivariate Cox proportional hazard analysis was performed to evaluate sUA as a predictor of CVD and coronary heart disease (CHD) mortality. Discriminative and recalibrative properties of sUA for CHD deaths were also assessed over traditional CVD risk factors. Net reclassification index (NRI) was calculated by comparing regression models incorporating traditional CVD risk factors with and without sUA.

Results: sUA was not predictive of either CVD mortality [model 4: hazards ratio (HR) 1.06, 95% confidence interval (CI) 0.96-1.16, p = 0.27] or CHD mortality (model 4: HR 1.06, 95% CI 0.94-1.19, p = 0.32). Addition of sUA to traditional CVD risk factors resulted in no significant increment in c-statistic, receiver-operating characteristics-area under curve, absolute NRI (0.5%, 95% CI -1.9 to 2.9%, p = 0.68), or intermediate NRI (2.5%, 95% CI -1.6 to 6.6%, p = 0.24) for prediction of hard CHD deaths.

Conclusions: sUA was not an independent predictor of both CVD and CHD mortality. Ethnicity did not influence the association of sUA with CVD mortality. Furthermore, sUA did not add to risk assessment beyond traditional CVD risk factors.
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http://dx.doi.org/10.1177/2047487313519346DOI Listing
April 2015

Non-high-density lipoprotein cholesterol and coronary artery calcium progression in a multiethnic US population.

Am J Cardiol 2014 Feb 9;113(3):471-4. Epub 2013 Nov 9.

Division of Cardiology, Department of Medicine, Wayne State University, Detroit Medical Center, Detroit, Michigan. Electronic address:

Non-high-density lipoprotein cholesterol (non-HDLc) is an independent predictor of cardiovascular disease risk, with elevated levels signifying an increased risk beyond low-density lipoprotein. Previous data have shown inconsistent association of lipid subfractions with progression of coronary artery calcium (CAC), a surrogate marker of incident cardiovascular disease. We sought to evaluate the association between non-HDLc and development (incident) and progression of CAC in a cohort of multiethnic asymptomatic subjects. The cohort (n = 5,705) was derived from the limited access data set of the Multi-Ethnic Study of Atherosclerosis obtained from the National Heart Lung and Blood Institute. Multivariable regression analysis was performed to derive the association between non-HDLc and incident CAC (n = 2,927) and non-HDLc and progression of CAC (n = 2,778). In the population without CAC at baseline, non-HDLc, especially >190 mg/dl, was independently associated with incident CAC (relative risk 1.40, 95% confidence interval 1.09 to 1.79, p = 0.008) after adjustments with age, gender, race, systolic blood pressure, antihypertension medication use, smoking, diabetes, lipid-lowering therapy use, follow-up duration, and waist-hip ratio. Similarly, among those with CAC at baseline, non-HDLc levels >190 mg/dl were associated with significant CAC progression in the overall population (β 16.4, 95% confidence interval -5.63 to 27.2, p = 0.003) after adjustments. In conclusion, non-HDLc levels, especially >190 mg/dl, are consistently associated with increased risk of CAC progression. Our results suggest that among lipid fractions, non-HDLc may be best suited for the prediction of future CAC progression.
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http://dx.doi.org/10.1016/j.amjcard.2013.10.027DOI Listing
February 2014

Cardiac magnetic resonance imaging in peripartum cardiomyopathy.

Am J Med Sci 2014 Feb;347(2):112-7

Division of Cardiology, Department of Internal Medicine (NPA, NM, TM, AK, LCA), Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan; and Department of Radiology (RD, TL), Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan.

Background: Peripartum cardiomyopathy (PPCM) is a rare life-threatening condition of unclear etiology. Data on the use of cardiac magnetic resonance (CMR) imaging to characterize PPCM are limited. This study was done to assess the role of CMR imaging for the diagnosis and prognostication of patients with PPCM.

Methods: Medical records of a tertiary medical center were screened for PPCM patients with CMR imaging done within the past 5 years (2006-2011). Images were reviewed by 2 expert radiologists (blinded to clinical data) using cine sequences for chamber function and size, T2-weighted images for the determination of edema (T2-ratio), and late gadolinium enhancement (LGE) sequences for myocardial tissue characterization.

Results: Ten PPCM patients (aged 28 ± 6 years, 90% African American) had a total of 15 CMR examinations: 4 in the acute phase (within 7 days of diagnosis) and 11 during follow-up (median, 12 months; range, 1-72 months). Left ventricular ejection fraction was decreased in all 4 initial scans. Elevated T2 ratio (>2) seen in 1 patient decreased on follow-up imaging. LGE was seen in 1 of the 4 acute-phase scans and in 4 of the 11 follow-up phase scans. These 4 patients had multiple readmissions because of heart failure exacerbations and persistently low left ventricular ejection fraction on subsequent echocardiograms.

Conclusions: LGE seems to be associated with a poor prognosis in the setting of PPCM. CMR imaging seems to have promising practical implications in the diagnosis and prognostication of PPCM patients.
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http://dx.doi.org/10.1097/MAJ.0b013e31828155e3DOI Listing
February 2014

Purulent pericardial effusion from community-acquired methicillin-resistant Staphylococcus aureus.

Am J Med Sci 2012 Aug;344(2):160-2

Division of Cardiology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit Medical Center, Michigan, USA.

Although the incidence of purulent pericarditis has decreased significantly in the modern antibiotic era, a high index of clinical suspicion should be maintained to diagnose this life-threatening illness at an early stage. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a global pathogen and notorious for its ability to cause infection in otherwise healthy individuals. However, it has been associated with purulent pericarditis only in some sporadic case reports. The authors describe a case of purulent pericardial effusion caused by CA-MRSA infection. To the best of our knowledge, this is only the fourth case of CA-MRSA pericarditis to be reported in English literature.
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http://dx.doi.org/10.1097/MAJ.0b013e31824e942bDOI Listing
August 2012

Verapamil toxicity causing anterograde atrioventricular blockade with preserved retrograde conduction: An electrophysiological paradox.

Cardiol J 2010 ;17(6):636-7

Division of Cardiology/Electrophysiology, Wayne State University, Detroit, MI, USA.

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March 2011

Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography.

Am J Cardiol 2010 Oct 11;106(7):1054-8. Epub 2010 Aug 11.

Division of Cardiology, Wayne State University, Detroit, Michigan, USA.

Patent foramen ovale (PFO) is associated with cryptogenic stroke, migraine headache, decompression sickness, and platypnea-orthodeoxia syndrome. Patients undergoing transesophageal echocardiography are often hypovolemic from preprocedural fasting and might not demonstrate right to left shunting owing to insufficient right atrial pressure generation, despite provocative maneuvers. We hypothesized that volume replenishment with saline loading could potentially unmask a PFO by favorably modulating the interatrial pressure gradient. Our study sought to examine the role of pre- or intraprocedural intravenous fluid replenishment on PFO detection during transesophageal echocardiography. A total of 103 patients were enrolled. An initial series of bubble injections was performed unprovoked and then with provocative maneuvers such as the Valsalva maneuver and coughing. The patients were then given a rapid 500 ml saline bolus, and the same sequence of bubble injections was repeated. The presence, type, and magnitude of the right to left shunts were noted before and after the saline bolus. The detection rate of PFO increased from 10.6% to 26.2% after saline loading without any provocative maneuvers. When combined with provocative maneuvers (Valsalva or cough), saline loading improved the detection rate from 17.4% to 32.0%. Overall, from amongst the 103 enrolled patients, saline bolusing resulted in a de novo diagnosis of PFO in 15 patients, atrial septal aneurysm in 15, PFO coexisting with an atrial septal aneurysm in 10, and pulmonary arteriovenous fistula in 5 patients. In conclusion, saline infusion in appropriately selected patients during transesophageal echocardiography significantly enhances the detection of PFOs and pulmonary arteriovenous fistulas.
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http://dx.doi.org/10.1016/j.amjcard.2010.05.037DOI Listing
October 2010

Myocardial cleft, crypt, diverticulum, or aneurysm? Does it really matter?

Clin Cardiol 2009 Aug;32(8):E48-51

Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.

Myocardial clefts are congenital abnormalities related to myocardial fiber or fascicle disarray that have been described in healthy volunteers as well as in the setting of hypertrophic cardiomyopathy. A cleft or crypt can be described as a discrete, approximately "V" shaped fissure extending into but confined by the myocardium, with a tendency to narrow or occlude in systole without local hypokinesia or dyskinesia. While little is known about the clinical significance of this entity, this report elaborates on the confounding terminology and differential diagnosis of this condition.
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http://dx.doi.org/10.1002/clc.20466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6653333PMC
August 2009
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