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Pradyumna Agasthi,Sai Harika Pujari,Farouk Mookadam,Andrew Tseng,Nithin R. Venepally,Panwen Wang,Mohamed Allam,John Sweeney,Mackram Eleid,Floyd David Fortuin,David R. Holmes Jr,Nirat Beohar,Reza Arsan 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.6
Purpose: Cardiac power (CP) index is a product of mean arterial pressure (MAP) and cardiac output (CO). In aortic stenosis, however, MAP is not reflective of true left ventricular (LV) afterload. We evaluated the utility of a gradient-adjusted CP (GCP) index in predicting survival after transcatheter aortic valve replacement (TAVR), compared to CP alone. Materials and Methods: We included 975 patients who underwent TAVR with 1 year of follow-up. CP was calculated as (CO×MAP)/[451×body surface area (BSA)] (W/m2). GCP was calculated using augmented MAP by adding aortic valve mean gradient (AVMG) to systolic blood pressure (CP1), adding aortic valve maximal instantaneous gradient to systolic blood pressure (CP2), and adding AVMG to MAP (CP3). A multivariate Cox regression analysis was performed adjusting for baseline covariates. Receiver operator curves (ROC) for CP and GCP were calculated to predict survival after TAVR. Results: The mortality rate at 1 year was 16%. The mean age and AVMG of the survivors were 81±9 years and 43±4 mm Hg versus 80±9 years and 42±13 mm Hg in the deceased group. The proportions of female patients were similar in both groups (p=0.7). Both CP and GCP were independently associated with survival at 1 year. The area under ROCs for CP, CP1, CP2, and CP3 were 0.67 [95% confidence interval (CI), 0.62–0.72], 0.65 (95% CI, 0.60–0.70), 0.66 (95% CI, 0.61–0.71), and 0.63 (95% CI 0.58–0.68), respectively. Conclusion: GCP did not improve the accuracy of predicting survival post TAVR at 1 year, compared to CP alone.
Sherif Moustafa,David J. Patton,Nanette Alvarez,Mansour Al Shanawani,Khalid AlDossari,Michael S. Connelly,Timothy Prieur,Farouk Mookadam 한국심초음파학회 2015 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.23 No.1
Double-chambered right ventricle (DCRV) is an uncommon congenital anomaly in which anomalous muscle bands divide theright ventricle into two chambers; a proximal high-pressure and distal low-pressure chamber. It may be associated with midright ventricular obstruction. It is commonly associated with other congenital anomalies, most frequently perimembranousventricular septal defect (PM-VSD). We herein present 5 adult patients with concomitant DCRV and PM-VSD who varied intheir symptomatic presentations and the ways of management.
Left Ventricular torsion Changes Post Kidney Transplantation
Yan Deng,Anil Pandit,Raymond L. Heilman,Harini A. Chakkera,Marek J. Mazur,Farouk Mookadam 한국심초음파학회 2013 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.21 No.4
Background: To quantify changes of left ventricular (LV) torsion in patients’ pre and post kidney transplantation. Methods: A prospective study was conducted on 48 patients who received kidney transplantation for end stage renal diseaseand without myocardial infarction. The rotation, twist and torsion of LV were studied pre and post kidney transplantation (6months post transplantation) using velocity vector imaging by echocardiography. The data is expressed as mean ± standarddeviation and compared by paired t-test at the p < 0.05 significance level. Results: Six months post kidney transplantation, left ventricular ejection fraction (from 40.33 ± 11.42 to 61.00 ± 13.68%),ratio of mitral early and late diastolic filling velocity (from 1.04 ± 0.57 to 1.21 ± 0.52), rotation of basal LV (from 4.48 ± 2.66 to5.65 ± 2.64 degree), rotation of apical LV (from 4.27 ± 3.08 to 5.50 ± 4.25 degree), LV twist (8.75 ± 4.45 to 11.14 ± 5.25degree) and torsion (from 1.06 ± 0.54 to 1.33 ± 0.61 degree/cm) were increased significantly (p < 0.05). Interventricular septumthickness (from 11.67 ± 2.39 to 9.67 ± 0.48 mm), left ventricular mass index (from 104.00 ± 16.47 to 95.50 ± 21.44 g/m2),systolic blood pressure (from 143.50 ± 34.99 to 121.50 ± 7.09 mmHg), serum blood urea nitrogen (from 42.40 ± 7.98 to 30.43± 13.85 mg/dL) and creatinine (from 4.53 ± 1.96 to 2.73 ± 2.57 mg/dL) were decreased significantly (p < 0.05). Conclusion: Kidney transplantation in end stage renal disease without myocardial infarction results in improvement in leftventricular structure, function and myocardial mechanics as detected by echocardiography and velocity vector imaging. Velocityvector imaging provided valuable information for detection and follow-up of cardiac abnormalities in patients with end stagerenal disease.