Updates on Cardiac Enlargement in US Firefighters. Maria Korre, MSc, ScD

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Updates on Cardiac Enlargement in US Firefighters. Maria Korre, MSc, ScD"

Transcription

1 Updates on Cardiac Enlargement in US Firefighters Maria Korre, MSc, ScD Research Associate-Instructor Environmental & Occupational Medicine & Epidemiology Program Department of Environmental Health Harvard T.H. Chan School of Public Health

2 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 2"

3 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 3"

4 Purpose & Objectives "! We' aim' to' present' a0ainable' and' prac5cal' approaches' to' improve'firefighter'health'and'safety'targeted'to'fire'service' leadership,'occupa5onal'medicine'physicians'and'individual' firefighters Specific Objectives 1. To raise awareness within the fire service about enlargement of the heart (including cardiomegaly and left ventricular (LV) hypertrophy) and how it increases the risk of developing CVD and on-duty SCD; as well as it s potential to be treated and reversed if recognized beforehand. 2. To summarize the current challenges we face in the identification of cardiac enlargement in active firefighters according to the method of assessment (see Chapter 1)

5 Specific Objectives 3. To more accurately estimate how common cardiac enlargement is among career US firefighters by combining the use of different imaging modalities along with other comprehensive clinical data (see Chapters 2 and 3) 4. To identify the most important predictors of LV mass in career male firefighters in the US so that more accurate medical screening programs can be implemented, allowing for the identification of LV hypertrophy/ cardiomegaly in a timely fashion, thus enabling clinical interventions to decrease firefighters morbidity and mortality (see Chapter 4). Purpose & Objectives " 5. To translate current understanding of research to practical recommendations that the fire service can champion in the areas of medical evaluations, fitness goals, and behavioral health changes.

6 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 6"

7 CVD'in'the'US'Fire'Service' Cardiovascular Disease (CVD) is the leading cause of on-duty deaths in US firefighters and a costly cause of morbidity (45% on-duty Deaths). For every fatal on-duty CVD event, there are an estimated additional nonfatal events. Recognition of Cardiovascular Stressors has led to Heart Presumption laws in 37 / 50 states and 2 Canadian Provinces. 7"

8 Physically'Demanding'&'Psychologically'Stressful'Work' 'Can'Trigger'CVD'in'Vulnerable'Individuals' Strenuous'work' Climbing"stairs" Forcible"entry" Search"and"rescue" Heavy'PPE" >"22"kg" "Metabolic""work" Heat""dissipa?on" Hot'and'Dangerous' Environment' Over"100º"C"rou?nely" Chao?c" Low"visibility" 8"

9 On-Duty Heart Events - NOT random in time (duty, hour, season) - NOT random among FF & LEO - MOST could be Prevented Triggering on Underlying Disease 9"

10 Adapted from Soteriades et al. Cardiology in Review "

11 ' '!!! Striking!Evidence'! LVH/cardiomegaly!plays!a!major!role! in!cvd!events!in!us!fire!service! 11"

12 LVH/cardiomegaly'plays'a'major'role'in'CVD'events'in'US'fire'service" Evidence for LVH in 76% of the autopsies of CHD deaths. LVH/cardiomegaly was mentioned in 60% of the autopsies. (Kales et al. Environmental Health 2003) (Geibe et al. Amer J Cardiol 2008) Among male SCD 81% had evidence of cardiomegaly. (Tavora et al. Pathology 2012) 12"

13 Sudden'Cardiac'Death'among'Firefighters' 45'Year'of'Age'in'the'United'States' Jang'J,'Teehan'D,'Farioli'A,'Smith'D,'Kales'SN.'2013" 13"

14 Theore5cal'model'of'Sudden'Cardiac'Death' 'in'firefighters' Adapted'from'Smith'DL,'Barr'DA,'Kales'SN.'2013' 14"

15 LVH/cardiomegaly'plays'a'major'role'in'CVD'events'in'US'fire'service" Obvious goal: detect LVH at an early stage and reverse it 15"

16 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 16"

17 Cardiac'Enlargement'' Cardiomegaly refers to enlargement of the heart in general as well as to an abnormally heavy heart by weight. Most pathologists consider a heart weight above 450 g in a man and 390 g in a woman to be abnormally heavy or consistent with cardiomegaly. LV hypertrophy is a related term that specifically refers to enlargement of the left ventricle and is usually defined as an increased thickness of the left ventricular wall as measured by a pathologist at autopsy or estimated by an imaging technique, or an elevated LV mass or weight of the left ventricle as measured by various imaging techniques.

18 Le['Ventricular'Mass'(LVM)'" There is a consensus that the presence of LVH is best determined by estimating the LVM. LVM occupies a unique place among CVD risk factors: determined by established risk factors (obesity, blood pressure, tobacco use) a strong independent predictor of CV events an increase in LVM is associated with a higher incidence of CV events 18"

19 Le['Ventricular'Mass'' ECHO'&'CMR" Echocardiography (ECHO) and Cardiac magnetic Resonance (CMR) are the two most frequently used imaging modalities for the assessment of LVM. CMR is considered the GOLD standard. ECHO is well validated, widely available. ECHO-derived LVM is usually performed in clinical practice and has shown prediction ability to CV outcomes. 19"

20 Le['Ventricular'Mass'Indices'' Wide distribution of LVM values in a healthy population. Absolute LVM values are limited by not accounting for physiologic variations related to body size. LVM index (LVMi) is usually derived by dividing LVM with a body size parameter (body surface area, height to an allometric power). LVH is defined by an LVMi greater than some specified cutoff value. The definition of LVH and its performance as a CV risk predictor is strongly related to the LVM indexing method. 20"

21 Le['Ventricular'Mass'Indices'' Indexing to BSA 1 st normalization process used Underestimates the prevalence of LVH in obese and overweight individuals Indexing to height 1.7 Higher sensitivity than index to BSA in identifying obesity-related LVH Best description of the LVM-body size relationship Consistently associated with cardiovascular events and all-cause death 21"

22 '''''''''''''''''The'phenomenon'of'Athlete s'heart' Adaptive rather than pathological hypertrophy. Type of training (strength-endurance) Strength training alone almost never causes physiologic hypertrophy High-intensity endurance training may result in LVM values that overlap with the LVH range, especially among males 22"

23 '''''''''''''''''The'phenomenon'of'Athlete s'heart' Reference ranges from only sedentary people - likelihood of classifying athletes as mild to moderate LV Hypertrophy If trained athletes are included in Control population -the upper limit of normal range for LVM is higher and there is a decreased sensitivity for detecting pathologic LVH 23"

24 '''''''''' ''''''''The'phenomenon'of'Athlete s'heart'? Are all changes associated with'athlete s'heart'truly'benign'?' (Rowland"et"al."Sports"Med,"2011")" ' 24"

25 Le['Ventricular'Mass'Indices'&'Hypertrophy'Defini5on'" LVMi Cutoff Values Women Men ECHO LVM/BSA >95 (g/m 2 ) >115 (g/m 2 ) LVM/height 1.7 >60 (g/m 1.7 ) >81(g/m 1.7 ) LVM/height 2.7 >47(g/m 2.7 ) >50(g/m 2.7 ) CMR LVM/BSA >84.6 (g/m 2 ) >106.2 (g/m 2 ) LVM/height 1.7 >60(g/m 1.7 ) >80(g/m 1.7 ) LVM/height 2.7 >38 (g/m 2.7 ) >45.1(g/m 2.7 ) Armstrong et al. Echocardiography "

26 Heart''Weight'' Challenges: Scientific evidence available relies largely on older autopsy studies ( s) Some studies have not excluded hearts with pathologic changes Ethnicity-specific reference standards Reference values can only be valid for a limited period of time Autopsies vary considerably 26"

27 Heart''Weight'' Reference Ranges General Population (Injury deaths with normal hearts) Men: Heart weight 365 +/- 71 grams Women: Heart weight 312 +/- 78 grams Grandmaison et al. Forensic Science Intl.2001 Average heart weight is found to be 30-40% greater in men than in women with a similar body weight. 27"

28 Rela5onship'of''LVM'to'Heart'Weight' " Most autopsies do not report individual ventricular weight, but rather they report the total heart weight. Paucity of direct comparisons between autopsy and imaging data. The limited data available suggest that LVM accounts for a much greater proportion of total cardiac mass in diseased hearts as compared to normal hearts. " 28"

29 Summary and Conclusions ECHO remains the most widely used and most accessible imaging modality for the assessment of LVM LVH definitions using LVM cut-off reference ranges demonstrate wide variability with a need of greater standardization There are only a few direct comparisons of ECHO and CMR The optimal method of indexing for body size remains a controversial issue Overlap of LVM in athletes hearts with abnormal ranges" 29"

30 Summary and Conclusions Autopsies measure routinely total cardiac mass as an indicator of potential cardiomegaly Very little autopsy data exist to facilitate direct comparisons between the mass of the left ventricle and the total cardiac mass Firm definition of LVH/cardiomegaly based on heart weight has not been established by consensus Heart weight can remain a good diagnostic criterion of autopsy only if reference ranges are regularly defined Need for updating the reference ranges for total heart weight 30"

31 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 31"

32 Study"Popula?on"1"

33 Defining'Cardiac'Enlargement'" 33"

34 Defining'Cardiac'Enlargement'' The choices on the imaging techniques, the reference ranges, the body size indexing affect who will be classified as having LVH. Autopsies rarely assess LVM, and instead they routinely measure total heart weight as an indicator of cardiomegaly. Evidence for the current status of cardiac enlargement in the US Fire Service is largely based on autopsy data from cardiac cases. 34"

35 Study'Popula5on'1' Ac5ve'Career'Firefighters'" LVH definitions per ECHO & CMR Weighted analysis was performed Weights were calculated based on the total number of risk factors per subject with the technique of inverse probability weighting 35"

36 Inclusion Criteria (1) age 65 years (2) duty-related death, and Study Population 2! Non cardiac Traumatic Fatalities" (3) cause of death determined by autopsy to be due to blunt trauma, burns, or asphyxiation and not related to any cardiovascular pathologic entity. Only male autopsy reports were included in this study. [293 reports for main analyses] Sensitivity analyses with data from all 353 autopsy records, assuming a BMI of 25 kg/m 2 and then 27 kg/m 2 for all 60 records with missing BMI information. " " 36"

37 Non'cardiac'Trauma5c'Fatali5es" Cardiomegaly/LVH definitions per autopsies Age and BMI adjustment based on the age and BMI distributions of the active career firefighter population." 37"

38 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 38"

39 LVH'Prevalence'Es5mates'by'ECHO'&'CMR' ECHO LVH Criteria per imaging modality LVM (>225g) Posterior Wall Thickness ( 1.2cm ) Study Sample (N=393) LVH (n,%) Study Sample unweighted 58 (15.3) 146 (14.1) 61 (16.0) 136 (13.1) Septal Wall Thickness 140 (36.7) 341 (32.8) ( 1.2cm ) LVM/BSA 13 (3.4) 34 (3.3) (>115 g/m 2 ) LVM/Height (18.7) 181 (17.5) (>81g/m 1.7 ) LVM/Height 2.7 (>50g/m 2.7 ) 34 (9.1) 90 (8.7) CMR LVM (>203.5g) 4 (1.1) 9 (1.0) Posterior Wall Thickness ( 1.2cm ) 21 (6.0) 50 (5.3) LVM/BSA (>106.2 g/m 2 ) 0 (0.0) 0 (0.0) LVM/Height 1.7 (>80g/m 1.7 ) 2 (0.6) 3 (0.4) LVM/Height 2.7 (>45.1g/m 1.7 ) 1 (0.3) 2 (0.2) 39"

40 Noncardiac'Trauma5c'Fatali5es" Cardiomegaly LVH & Cardiomegaly Criteria Quantitative Definition ( 450 g) Qualitative Definition (Heart size abnormality noted) LVH & Cardiomegaly Prevalence n(%) 103 (33.8) 60 (19.6) LVH Quantitative Definition ( 1.2cm ) 121 (41.5) Qualitative Definition (Increased Wall Thickness noted) 44 (13.7) 40"

41 Noncardiac'Trauma5c'Fatali5es" Heart weight and LV wall thickness steadily increased with increasing age and BMI. Both remained significant after adjusting for the other parameter. " 41"

42 Summary'' LVH prevalence estimates had a range from 3.3% to 32.8% by ECHO measurements LVH prevalence estimates had a range from 0.0% to 5.3% by CMR measurements LVH was present in 17.5% and 0.4% of the active firefighters as defined by LVM indexed to height 1.7 (by ECHO and CMR, respectively) LVM indexed to BSA as measured by CMR indicated zero prevalence of LVH Among noncardiac traumatic autopsies, cardiomegaly and LVH were prevalent in 33.8% and 41.5% respectively, even after adjustment for age and BMI 42"

43 Conclusions Significant potential impact of the choices of the clinicians or the researchers Criteria by CMR measurements presented unrealistically low prevalence estimates BMI was a major driver of heart weight Measurement of LV wall thickness on average was similar across imaging and autopsies Urgent need for outcome-based studies Standardization of the forms of the autopsy reports across protocols and jurisdictions 43"

44 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 44"

45 Mul5variate'Linear'Regression'Models' A 1-unit decrease in BMI was associated with 1 unit (kg/m 1.7 ) reduction of LVM/ height 1.7 after adjustment for age, HTN, OSA risk and cardiorespiratory fitness. 45"

46 Summary'' BMI to be the strongest and consistent independent predictor of LVM indexed by height to the allometric powers of 1.7 and 2.7 A 1-unit decrease in BMI was associated with 1 unit (kg/m 1.7 ) reduction of LVM/ height 1.7 after adjustment for age, HTN, OSA risk and cardiorespiratory fitness 46"

47 Purpose & Objectives Background Overview' Chapter 1: Current Challenges in the Identification of Cardiac Enlargement Chapter 2: Methods by Imaging Modalities and Autopsies Study Population 1 (Non-Invasive Assessment/ Imaging) Study Population 2: Direct Measures Of Heart Weight And Wall Thickness (Autopsy Reports) Chapter 3:Cardiac Enlargement in U.S. Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance & Autopsies Chapter 4: Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters Conclusions, Recommendations & Clinical Implications 47"

48 Conclusions,'Recommenda5ons'&'Clinical'Implica5ons'' " Korre M, Kales SN et al Am J Cardiol 2016: BMI is driving LVM. Korre M, Kales SN et al J Clin Exp Cardiolog 2016: BMI is driving LV wall thickness and heart weight. Korre M, Kales SN et al J Integ Cardiolog 2016: LVM accounts for a greater proportion of total heart weight in diseased hearts Take Home Message for Clinicians: Implement targeted screening for LVH and cardiomegaly for obese firefighters, as well as those with uncontrolled or chronic hypertension or obstructive sleep apnea

49 Conclusions,'Recommenda5ons'&'Clinical'Implica5ons'' " Previous Study (Yang et al.2013): SCD among younger firefighters was largely driven by an increased cardiac mass in SCD victims compared to controls. 2/3 of SCD victims were obese Korre M, Kales SN et al Am J Cardiol 2016: BMI is driving LVM. Take Home Message : Decreasing obesity in the fire service will improve firefighters CV risk profiles, including their risk of LVH. Significant reduction in on-duty CVD events, particularly SCD.

50 Let s together lead the way forward to improve health & employment outcomes among US Firefighters. https://www.everyonegoeshome.com/2017/07/25/cardiacwhite-paper/

51 Dr.'Stefanos'N.Kales' Harvard'T.H'Chan'School'of'Public'Health'" EOME"program"" Harvard"Research"Team"" " Skidmore'College' Dr."Denise"Smith" Ms"Jeannie"Haller""" Skidmore"Research"Team"" " University'of'Bologna'' Dr."Andrea"Farioli" " University'of'Brasilia/HSPH' Dr."Luiz"G.G."Porto"" " Na5onal'Fallen'Firefighter'Founda5on'' Acknowledgments Public'Safety'Medical' Dr."Steven"Moffab" Ms"Lora"Lex" Ms"Carolyn"Muegge" Mr"Nelson"Hale" " Indiana'University'' Dr."Richard"Kovacs" Dr."Ronald"Mastouri"" Ms"Roxanne"Kovacs" ' All'par5cipa5ng'Firefighters,Collabora5ng' Ci5es,'Clinics,'Researchers' ' Funding'Sources' FEMA"AFG"program s"award"emwz2011z FPZ00663"(PI:"Dr."S.N.Kales)"&" EMWZ2013ZFPZ00749"(PI:"Dr."D.L.Smith)."" " Harvard"Tui?on"Scholarship" " Research"Assistantship"_SNK"research"team"""" 51"

52 Thank You!! 52"

Ref 1. Ref 2. Ref 3. Ref 4. See graph

Ref 1. Ref 2. Ref 3. Ref 4. See graph Ref 1 Ref 2 Ref 3 1. Ages 6-23 y/o 2. Significant LVM differences by gender 3. For males 95 th percentiles: a. LVM/BSA = 103 b. LVM/height = 100 4. For females 95 th percentiles: a. LVM/BSA = 84 b. LVM/height

More information

Carl J. Lavie, MD, FACC, FACP, FCCP

Carl J. Lavie, MD, FACC, FACP, FCCP Untangling the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox Carl J. Lavie, MD, FACC, FACP, FCCP Professor of Medicine Medical Director, Cardiac Rehabilitation and Preventive Cardiology

More information

2/11/2017. Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox. Disclosures. Carl J. Lavie, MD, FACC, FACP, FCCP

2/11/2017. Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox. Disclosures. Carl J. Lavie, MD, FACC, FACP, FCCP Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox Carl J. Lavie, MD, FACC, FACP, FCCP Professor of Medicine Medical Director, Cardiac Rehabilitation and Preventive Cardiology

More information

How NOT to miss Hypertrophic Cardiomyopathy? Adaya Weissler-Snir, MD University Health Network, University of Toronto

How NOT to miss Hypertrophic Cardiomyopathy? Adaya Weissler-Snir, MD University Health Network, University of Toronto How NOT to miss Hypertrophic Cardiomyopathy? Adaya Weissler-Snir, MD University Health Network, University of Toronto Introduction Hypertrophic cardiomyopathy is the most common genetic cardiomyopathy,

More information

Evaluation of Left Ventricular Function and Hypertrophy Gerard P. Aurigemma MD

Evaluation of Left Ventricular Function and Hypertrophy Gerard P. Aurigemma MD Evaluation of Left Ventricular Function and Hypertrophy Gerard P. Aurigemma MD Board Review Course 2017 43 year old health assistant Severe resistant HTN LT BSA 2 Height 64 1 Here is the M mode echocardiogram

More information

Dr. Dermot Phelan MB BCh BAO PhD European Society of Cardiology 2012

Dr. Dermot Phelan MB BCh BAO PhD European Society of Cardiology 2012 Relative Apical Sparing of Longitudinal Strain Using 2- Dimensional Speckle-Tracking Echocardiography is Both Sensitive and Specific for the Diagnosis of Cardiac Amyloidosis. Dr. Dermot Phelan MB BCh BAO

More information

Echocardiographic definition of left ventricular hypertrophy in the hypertensive: which method of indexation of left ventricular mass?

Echocardiographic definition of left ventricular hypertrophy in the hypertensive: which method of indexation of left ventricular mass? Journal of Human Hypertension (1999) 13, 505 509 1999 Stockton Press. All rights reserved 0950-9240/99 $12.00 http://www.stockton-press.co.uk/jhh ORIGINAL ARTICLE Echocardiographic definition of left ventricular

More information

The Relationship Between Measures Of Obesity And Echocardiographic Determinants Of Left Ventricular Hypertrophy In Nigerian Adults

The Relationship Between Measures Of Obesity And Echocardiographic Determinants Of Left Ventricular Hypertrophy In Nigerian Adults ISPUB.COM The Internet Journal of Cardiology Volume 9 Number The Relationship Between Measures Of Obesity And Echocardiographic Determinants Of Left Ventricular O IC, A OS, O OJ, U DI Citation O IC, A

More information

Journal of the American College of Cardiology Vol. 33, No. 6, by the American College of Cardiology ISSN /99/$20.

Journal of the American College of Cardiology Vol. 33, No. 6, by the American College of Cardiology ISSN /99/$20. Journal of the American College of Cardiology Vol. 33, No. 6, 1999 1999 by the American College of Cardiology ISSN 0735-1097/99/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00050-9 Familial

More information

*(a) Describe the blood clotting process. (4)

*(a) Describe the blood clotting process. (4) 1 There are many venomous (poisonous) snakes in the world. Many of the venoms from these snakes affect the blood clotting process. *(a) Describe the blood clotting process. (4) (b) Factor Xa is a clotting

More information

Genotype Positive/ Phenotype Negative: Is It a Disease?

Genotype Positive/ Phenotype Negative: Is It a Disease? Genotype Positive/ Phenotype Negative: Is It a Disease? Michelle Michels MD, PhD Center of Inherited Cardiovascular Diseases Erasmus MC, Rotterdam, the Netherlands No disclosures What is phenotype negative

More information

Athlete s Heart vs. Cardiomyopathy

Athlete s Heart vs. Cardiomyopathy Athlete s Heart vs. Cardiomyopathy Linda D. Gillam, MD, MPH, FASE Chair, Department of Cardiovascular Medicine Medical Director, Cardiovascular Service Line Former Team Cardiologist to the New York Jets

More information

The new Guidelines: Focus on Chronic Heart Failure

The new Guidelines: Focus on Chronic Heart Failure The new Guidelines: Focus on Chronic Heart Failure Petros Nihoyannopoulos MD, FRCP, FESC Professor of Cardiology Imperial College London and National & Kapodistrian University of Athens 2 3 4 The principal

More information

Training adaptation of the heart according to the static-dynamic components of sports and seasonal changes in the athletes heart

Training adaptation of the heart according to the static-dynamic components of sports and seasonal changes in the athletes heart Training adaptation of the heart according to the static-dynamic components of sports and seasonal changes in the athletes heart Abstract of the PhD Thesis Eszter Csajági MD Doctoral School of Sport Sciences

More information

Multiple Gated Acquisition (MUGA) Scanning

Multiple Gated Acquisition (MUGA) Scanning Multiple Gated Acquisition (MUGA) Scanning Dmitry Beyder MPA, CNMT Nuclear Medicine, Radiology Barnes-Jewish Hospital / Washington University St. Louis, MO Disclaimers/Relationships Standard of care research

More information

Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM I have no disclosures to make.

Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM I have no disclosures to make. Maryland College of Occupational and Environmental Medicine April 2014 Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM fczarnecki@gablesgroup.com I have no disclosures to make. Guidelines 2006: Joint Task

More information

Prevalence of left ventricular hypertrophy in a hypertensive population

Prevalence of left ventricular hypertrophy in a hypertensive population European Heart Journal (1996) 17, 143-149 Prevalence of left ventricular hypertrophy in a hypertensive population J. Tingleff, M. Munch, T. J. Jakobsen, C. Torp-Pedersen, M. E. Olsen, K. H. Jensen, T.

More information

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER:

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER: ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM General Instructions: The Heart Failure Hospital Record Abstraction Form is completed for all heart failure-eligible cohort hospitalizations. Refer to

More information

HYPERTROPHY: Behind the curtain. V. Yotova St. Radboud Medical University Center, Nijmegen

HYPERTROPHY: Behind the curtain. V. Yotova St. Radboud Medical University Center, Nijmegen HYPERTROPHY: Behind the curtain V. Yotova St. Radboud Medical University Center, Nijmegen Disclosure of interest: none Relative wall thickness (cm) M 0.22 0.42 0.43 0.47 0.48 0.52 0.53 F 0.24 0.42 0.43

More information

A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean Patients

A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean Patients Original Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean

More information

ARRHYTHMIAS AND DEVICE THERAPY

ARRHYTHMIAS AND DEVICE THERAPY Topic List A BASICS 1 History of Cardiology 2 Clinical Skills 2.1 History Taking 2.2 Physical Examination 2.3 Electrocardiography 2.99 Clinical Skills - Other B IMAGING 3 Imaging 3.1 Echocardiography 3.2

More information

THE EFFECT OF WEIGHT LOSS AND EXERCISE ON CARDIOVASCULAR STRUCTURE AND FUNCTION IN CLASS II AND III OBESE WOMEN. Steven David Verba

THE EFFECT OF WEIGHT LOSS AND EXERCISE ON CARDIOVASCULAR STRUCTURE AND FUNCTION IN CLASS II AND III OBESE WOMEN. Steven David Verba THE EFFECT OF WEIGHT LOSS AND EXERCISE ON CARDIOVASCULAR STRUCTURE AND FUNCTION IN CLASS II AND III OBESE WOMEN by Steven David Verba B.S., Slippery Rock University, 2007 M.S., University of Pittsburgh,

More information

Right ventricular adaptation in endurance athletes. António Freitas. No conflict of interest

Right ventricular adaptation in endurance athletes. António Freitas. No conflict of interest The role of echocardiography in sports cardiology Right ventricular adaptation in endurance athletes. António Freitas Cardiology Department - Fernando Fonseca Hospital Lisbon Sports Medicine Centre - Lisbon

More information

2/9/2017. Financial Disclosures/Unapproved Use. Achieving Harmony in Blood Pressure Guidelines Around the Globe. Roger S. Blumenthal, MD.

2/9/2017. Financial Disclosures/Unapproved Use. Achieving Harmony in Blood Pressure Guidelines Around the Globe. Roger S. Blumenthal, MD. Achieving Harmony in Blood Pressure Guidelines Around the Globe Roger S. Blumenthal, MD The Kenneth Jay Pollin Professor of Cardiology Director, The Johns Hopkins Ciccarone Center for the Prevention Of

More information

Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo?

Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo? Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo? Prof. Massimo Salvetti Clinica Medica University of Brescia Percieved risk Actual risk Sehestedt et al,

More information

CARDIOVASCULAR DISEASE ASSESSMENT IN PREGNANT AND POSTPARTUM WOMEN

CARDIOVASCULAR DISEASE ASSESSMENT IN PREGNANT AND POSTPARTUM WOMEN ! ASSESSMENT IN PREGNANT AND POSTPARTUM WOMEN Afshan'Hameed,'MD' 'University'of'California,'Irvine'Medical'Center' Elyse'Foster,'MD' 'University'of'California,'San'Francisco' Elliott'Main,'MD' 'California'Maternal'Quality'Care'Collaborative'

More information

The Athlete s Heart. Critical Role of Echo. Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University

The Athlete s Heart. Critical Role of Echo. Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University The Athlete s Heart Critical Role of Echo Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University Washington, D.C. Disclosures Grant support (to institution)

More information

Association of body surface area and body composition with heart structural characteristics of female swimmers

Association of body surface area and body composition with heart structural characteristics of female swimmers Original Research Association of body surface area and body composition with heart structural characteristics of female swimmers BAHAREH SHEIKHSARAF 1, NIKBAKHT HOJAT ALLAH 2, and AZARBAYJANI MOHAMMAD

More information

HFPEF Echo with Strain vs. MRI T1 Mapping

HFPEF Echo with Strain vs. MRI T1 Mapping HFPEF Echo with Strain vs. MRI T1 Mapping Erik Schelbert, MD MS Director, Cardiovascular Magnetic Resonance Assistant Professor of Medicine Heart & Vascular Institute University of Pittsburgh Disclosures

More information

The Athlete s Heart. Role of Echo. Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University

The Athlete s Heart. Role of Echo. Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University The Athlete s Heart Role of Echo Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University Washington, D.C. Disclosures Grant support (to institution) for Core

More information

Does TEVAR affect the heart?

Does TEVAR affect the heart? Does TEVAR affect the heart? Christos D. Liapis, MD, FACS, FRCS, FEBVS Professor (Em) of Vascular Surgery National & Kapodistrian University of Athens Director Vascular & Endovascular Clinic Athens Medical

More information

D Terentes-Printzios, C Vlachopoulos, G Vyssoulis, N Ioakeimidis, P Xaplanteris, K Aznaouridis, E Christoforatou, A Samentzas, A Siama, C Stefanadis

D Terentes-Printzios, C Vlachopoulos, G Vyssoulis, N Ioakeimidis, P Xaplanteris, K Aznaouridis, E Christoforatou, A Samentzas, A Siama, C Stefanadis Peripheral Vessels Unit, 1st Department of Cardiology Athens Medical School Hippokration Hospital, Athens, Greece D Terentes-Printzios, C Vlachopoulos, G Vyssoulis, N Ioakeimidis, P Xaplanteris, K Aznaouridis,

More information

Cardiology for the Practitioner Advanced Cardiac Imaging: Worth the pretty pictures?

Cardiology for the Practitioner Advanced Cardiac Imaging: Worth the pretty pictures? Keenan Research Centre Li Ka Shing Knowledge Institute Cardiology for the Practitioner Advanced Cardiac Imaging: Worth the pretty pictures? Howard Leong-Poi, MD, FRCPC Associate Professor of Medicine St.

More information

The target blood pressure in patients with diabetes is <130 mm Hg

The target blood pressure in patients with diabetes is <130 mm Hg Controversies in hypertension, About Diabetes diabetes and and metabolic Cardiovascular syndrome Risk ESC annual congress August 29, 2011 The target blood pressure in patients with diabetes is

More information

2/11/2017. The Role of Exercise in Weight Loss and Maintanence. Disclosures

2/11/2017. The Role of Exercise in Weight Loss and Maintanence. Disclosures The Role of Exercise in Weight Loss and Maintanence Carl J. Lavie, MD, FACC, FACP, FCCP Professor of Medicine Medical Director, Cardiac Rehabilitation and Preventive Cardiology Director, Exercise Laboratories

More information

Selected age-associated changes in the cardiovascular system

Selected age-associated changes in the cardiovascular system Selected age-associated changes in the cardiovascular system Tamara Harris, M.D., M.S. Chief, Interdisciplinary Studies of Aging Acting Co-Chief, Laboratory of Epidemiology and Population Sciences Intramural

More information

Vascular Diseases. Overview: Selected Slides

Vascular Diseases. Overview: Selected Slides Vascular Diseases Overview: Selected Slides Total deaths and change in vascular death rates

More information

Hypertrophic Cardiomyopathy: beyond gradient and wall thickness

Hypertrophic Cardiomyopathy: beyond gradient and wall thickness Hypertrophic Cardiomyopathy: beyond gradient and wall thickness Michael H. Picard, M.D. Massachusetts General Hospital Harvard Medical School no disclosures special thanks to A. Baggish 1 Hypertrophic

More information

Title:Validation study of candidate single nucleotide polymorphisms associated with left ventricular hypertrophy in the Korean population

Title:Validation study of candidate single nucleotide polymorphisms associated with left ventricular hypertrophy in the Korean population Author's response to reviews Title:Validation study of candidate single nucleotide polymorphisms associated with left ventricular hypertrophy in the Korean population Authors: Jin-Kyu Park (cardiohy@gmail.com)

More information

CT for Myocardial Characterization of Cardiomyopathy. Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea

CT for Myocardial Characterization of Cardiomyopathy. Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea CT for Myocardial Characterization of Cardiomyopathy Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea Cardiomyopathy Elliott P et al. Eur Heart J 2008;29:270-276 The European Society

More information

Echocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016

Echocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016 Echocardiographic Evaluation of the Cardiomyopathies Stephanie Coulter, MD, FACC, FASE April, 2016 Cardiomyopathies (CMP) primary disease intrinsic to cardiac muscle Dilated CMP Hypertrophic CMP Infiltrative

More information

Global left ventricular circumferential strain is a marker for both systolic and diastolic myocardial function

Global left ventricular circumferential strain is a marker for both systolic and diastolic myocardial function Global left ventricular circumferential strain is a marker for both systolic and diastolic myocardial function Toshinari Onishi 1, Samir K. Saha 2, Daniel Ludwig 1, Erik B. Schelbert 1, David Schwartzman

More information

Imaging Assessment of the Pulmonary Valve in Stenosis/Atresia and Regurgitation

Imaging Assessment of the Pulmonary Valve in Stenosis/Atresia and Regurgitation Imaging Assessment of the Pulmonary Valve in Stenosis/Atresia and Regurgitation Craig E Fleishman, MD FACC FASE The Heart Center at Arnold Palmer Hospital for Children SCAI Fall Fellows Course 2014 Las

More information

MAYON VOLCANO: FAST FACTS

MAYON VOLCANO: FAST FACTS MAYON VOLCANO: FAST FACTS Type of Volcano: Stratovolcano Elevation: 2.46 km Base Diameter: 20 km Base Circumference: 62.8 km Area: 314.1 km 2 Reference: http://www.phivolcs.dost.gov.ph/html/update_vmepd/volcano/volcanolist/mayon.htm

More information

Sudden Death (SD) and hypertrophic cardiomyopathy (HCM) Attempt of risk stratification

Sudden Death (SD) and hypertrophic cardiomyopathy (HCM) Attempt of risk stratification Sudden Death (SD) and hypertrophic cardiomyopathy (HCM) Attempt of risk stratification 84th Annual Scientific Meeting of the Aerospace Medical Association May 12-16, 2013 Sheraton Chicago Hotel & Towers,

More information

Heart Failure with preserved ejection fraction (HFpEF)

Heart Failure with preserved ejection fraction (HFpEF) Heart Failure with preserved ejection fraction (HFpEF) Dr. Pierpaolo Pellicori Hull York Medical School Kingston-upon-Hull United Kingdom Conflict of interest: none Heart failure is a contemporary problem

More information

Age 18 years and older BMI 18.5 and < 25 kg/m 2

Age 18 years and older BMI 18.5 and < 25 kg/m 2 Quality ID #128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan National Quality Strategy Domain: Community/Population Health 2018 OPTIONS F INDIVIDUAL MEASURES:

More information

Diastolic Heart Function: Applying the New Guidelines Case Studies

Diastolic Heart Function: Applying the New Guidelines Case Studies Diastolic Heart Function: Applying the New Guidelines Case Studies Mitral Regurgitation The New ASE William Guidelines: A. Zoghbi Role MD, of FASE, 2D/3D MACCand CMR Professor and Chairman, Department

More information

SOUND HEALTH & WELLNESS TRUST

SOUND HEALTH & WELLNESS TRUST WEIGHT LOSS SURGERY POLICY SOUNDPLUS PPO AND SOUND PPO PLANS All procedures approved by the Plan must be pre-authorized by Aetna (the Trust s Utilization Management Vendor) and care must be provided by

More information

Management of Stage B Heart Failure

Management of Stage B Heart Failure KSC 2017 Management of Stage B Heart Failure Byung Su Yoo, MD., PhD. Division of Cardiology, Wonju College of Medicine, Yonsei University, South Korea Focused on Symptom ASLVSD, ASLVDD LVH HF progression

More information

Cardiac Risk Factors and Noninvasive Cardiac Diagnosis-ECG, ECHO, et al. Martin C. Burke, DO, FACOI ACOI IM Board Review Course 2018

Cardiac Risk Factors and Noninvasive Cardiac Diagnosis-ECG, ECHO, et al. Martin C. Burke, DO, FACOI ACOI IM Board Review Course 2018 Cardiac Risk Factors and Noninvasive Cardiac Diagnosis-ECG, ECHO, et al. Martin C. Burke, DO, FACOI ACOI IM Board Review Course 2018 No Disclosures The American Heart Association Evidence-Based Scoring

More information

Genetics and Management Approaches to Hypertrophic Cardiomyopathy

Genetics and Management Approaches to Hypertrophic Cardiomyopathy Genetics and Management Approaches to Hypertrophic Cardiomyopathy N. A. Mark Estes III MD Professor of Medicine Tufts University School of Medicine Director, New England Cardiac Arrhythmia Center Tufts

More information

Age 18 years and older BMI 18.5 and < 25 kg/m 2

Age 18 years and older BMI 18.5 and < 25 kg/m 2 Quality ID #128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan National Quality Strategy Domain: Community/Population Health 2018 OPTIONS F INDIVIDUAL MEASURES:

More information

Update on use of cardiac MRI in ARVC/D. Stefan L. Zimmerman, MD Johns Hopkins University Department of Radiology

Update on use of cardiac MRI in ARVC/D. Stefan L. Zimmerman, MD Johns Hopkins University Department of Radiology Update on use of cardiac MRI in ARVC/D Stefan L. Zimmerman, MD Johns Hopkins University Department of Radiology Outline Background Diagnosis Characteristic imaging findings Genetics of ARVC Genotype phenotype

More information

Normal Parameters: Age 65 years and older BMI 23 and < 30 kg/m 2 Age years BMI 18.5 and < 25 kg/m 2

Normal Parameters: Age 65 years and older BMI 23 and < 30 kg/m 2 Age years BMI 18.5 and < 25 kg/m 2 Measure #128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan National Quality Strategy Domain: Community/Population Health 2015 PQRS OPTIONS F INDIVIDUAL MEASURES:

More information

Martin G. Keane, MD, FASE Temple University School of Medicine

Martin G. Keane, MD, FASE Temple University School of Medicine Martin G. Keane, MD, FASE Temple University School of Medicine Measurement of end-diastolic LV internal diameter (LVIDd) made by properly-oriented M-Mode techniques in the Parasternal Long Axis View (PLAX):

More information

J Cardiovasc Med 2013, 14: a The Israeli Air Force Aero Medical Center, Tel Hashomer, b Department of

J Cardiovasc Med 2013, 14: a The Israeli Air Force Aero Medical Center, Tel Hashomer, b Department of CE: amrta; JCM/21761; Total nos of Pages: 6; JCM 21761 Original article M-mode echocardiographic values in a cohort of young healthy individuals Alon Grossman a,b, Michal Benderly c,d, Alex Prokupetz a,

More information

Modifiable Up-Stream Risk Factors:

Modifiable Up-Stream Risk Factors: Modifiable Up-Stream Risk Factors: Recent Studies in AF Prevention Behzad Pavri, MD, FACC, FHRS Professor of Medicine Director, CCEP Fellowship Thomas Jefferson University Hospital, Philadelphia, USA Disclosures

More information

National Sleep Disorders Research Plan

National Sleep Disorders Research Plan Research Plan Home Foreword Preface Introduction Executive Summary Contents Contact Us National Sleep Disorders Research Plan Return to Table of Contents SECTION 5 - SLEEP DISORDERS SLEEP-DISORDERED BREATHING

More information

VECTORS OF CONTRACTION

VECTORS OF CONTRACTION 1/3/216 Strain, Strain Rate, and Torsion: Myocardial Mechanics Simplified and Applied VECTORS OF CONTRACTION John Gorcsan, MD University of Pittsburgh, Pittsburgh, PA Shortening Thickening Twisting No

More information

Ejection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction

Ejection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Keith Miller MD Diastolic Heart Failure Risk Factors Common Risk Factors Aging Female gender Obesity Hypertension Diabetes mellitus

More information

Normal ECG And ECHO Findings in Athletes

Normal ECG And ECHO Findings in Athletes Normal ECG And ECHO Findings in Athletes Dr.Yahya Kiwan Consultant Interventional Cardiologist Head Of Departement Of Cardiology Canadian Specialist Hospital Sinus Bradycardia The normal heartbeat is initiated

More information

Cardiovascular Diseases in CKD

Cardiovascular Diseases in CKD 1 Cardiovascular Diseases in CKD Hung-Chun Chen, MD, PhD. Kaohsiung Medical University Taiwan Society of Nephrology 1 2 High Prevalence of CVD in CKD & ESRD Foley RN et al, AJKD 1998; 32(suppl 3):S112-9

More information

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics. DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this

More information

Sleep Apnea. Center For Cardiac Fitness Pulmonary Rehab Program The Miriam Hospital

Sleep Apnea. Center For Cardiac Fitness Pulmonary Rehab Program The Miriam Hospital Sleep Apnea Center For Cardiac Fitness Pulmonary Rehab Program The Miriam Hospital Outline Define sleep apnea Causes and risk factors Diagnosis Cardiovascular consequences Treatment Summary What is sleep

More information

Myths, Heart Disease and the Latino Population. Maria T. Vivaldi MD MGH Women s Heart Health Program. Hispanics constitute 16.3 % of US population!

Myths, Heart Disease and the Latino Population. Maria T. Vivaldi MD MGH Women s Heart Health Program. Hispanics constitute 16.3 % of US population! Myths, Heart Disease and the Latino Population Maria T. Vivaldi MD MGH Women s Heart Health Program Hispanics constitute 16.3 % of US population! 1 LEADING CAUSES OF DEATH IN LATINOS Heart disease is the

More information

Pulmonary Hypertension: Another Use for Viagra

Pulmonary Hypertension: Another Use for Viagra Pulmonary Hypertension: Another Use for Viagra Kathleen Tong, MD Director, Heart Failure Program Assistant Clinical Professor University of California, Davis Disclosures I have no financial conflicts A

More information

April 22, 2017 Abraham Rothman, MD

April 22, 2017 Abraham Rothman, MD April 22, 2017 Abraham Rothman, MD University of Nevada School of Medicine } Definitions } Adults } Children } Heart beats } Children and adolescents who want to participate in intensive exercise. } Just

More information

Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know

Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know James F. Burke, MD Program Director Cardiovascular Disease Fellowship Lankenau Medical Center Disclosure Dr. Burke has no conflicts

More information

Chronic Pediatric Hypertension

Chronic Pediatric Hypertension Chronic Pediatric Hypertension Nephrology Grand Round 3/13/2015 Mahmoud Kallash M.D Outline Definition of hypertension (HTN) Challenges in diagnosing HTN Epidemiology Causes and evaluation of HTN Management

More information

Obstructive Sleep Apnea in Truck Drivers

Obstructive Sleep Apnea in Truck Drivers Rocky Mountain Academy of Occupational and Environmental Medicine Denver, Colorado February 6, 2010 Obstructive Sleep Apnea in Truck Drivers Philip D. Parks, MD, MPH, MOccH Medical Director, Lifespan Health

More information

KDIGO LESSONS LEARNED FROM NEPHROLOGY TRIALS WITH RESPECT TO HEART FAILURE

KDIGO LESSONS LEARNED FROM NEPHROLOGY TRIALS WITH RESPECT TO HEART FAILURE LESSONS LEARNED FROM NEPHROLOGY TRIALS WITH RESPECT TO HEART FAILURE Dr. Christopher T Chan Director Division of Nephrology University Health Network Professor of Medicine University of Toronto Disclosure

More information

Component of Statistics Canada Catalogue no X Health Fact Sheets. Article. Body Composition of Canadian Adults 2007 to 2009.

Component of Statistics Canada Catalogue no X Health Fact Sheets. Article. Body Composition of Canadian Adults 2007 to 2009. Component of Statistics Canada Catalogue no. 82-625-X Health Fact Sheets Article Body Composition of Canadian Adults 2007 to 2009 January 2010 How to obtain more information For information about this

More information

Reoperation Bariatric Surgery:

Reoperation Bariatric Surgery: Reoperative Bariatric Surgery, Achieving Insurance Authorization Achieving insurance authorization for reoperative bariatric procedures is not difficult provided that prior insurance company authorization

More information

Quality Payment Program: Cardiology Specialty Measure Set

Quality Payment Program: Cardiology Specialty Measure Set Quality Payment Program: Cardiology Specialty Set Title Number CMS Reporting Method(s) Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for

More information

Risk Stratification for CAD for the Primary Care Provider

Risk Stratification for CAD for the Primary Care Provider Risk Stratification for CAD for the Primary Care Provider Shimoli Shah MD Assistant Professor of Medicine Directory, Ambulatory Cardiology Clinic Knight Cardiovascular Institute Oregon Health & Sciences

More information

Which method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호

Which method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호 Which method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호 Arterial stiffness Arterial stiffness is inversely related to arterial

More information

Stress and the Heart. Kim A. Poli MD, FACC Assistant Professor of Medicine Division of Cardiology, Albany Medical Center

Stress and the Heart. Kim A. Poli MD, FACC Assistant Professor of Medicine Division of Cardiology, Albany Medical Center Stress and the Heart Kim A. Poli MD, FACC Assistant Professor of Medicine Division of Cardiology, Albany Medical Center Thoughts in your mind have made you what you are, and thoughts in your mind will

More information

Hypertension Update Clinical Controversies Regarding Age and Race

Hypertension Update Clinical Controversies Regarding Age and Race Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT

More information

Chamber Quantitation Guidelines: What is New?

Chamber Quantitation Guidelines: What is New? Chamber Quantitation Guidelines: What is New? Roberto M Lang, MD J AM Soc Echocardiogr 2005; 18:1440-1463 1 Approximately 10,000 citations iase in itune Cardiac Chamber Quantification: What is New? Database

More information

ARCHIVE. Alberta WCB Policies & Information

ARCHIVE. Alberta WCB Policies & Information 1. Under what circumstances is a psychiatric or psychological injury 2. How does WCB determine whether a psychiatric or psychological injury is WCB will consider a claim for psychiatric or psychological

More information

Pearls & Pitfalls in nuclear cardiology

Pearls & Pitfalls in nuclear cardiology Pearls & Pitfalls in nuclear cardiology Maythinee Chantadisai, MD., NM physician Division of Nuclear Medicine, Department of radiology, KCMH Principle of myocardial perfusion imaging (MPI) Radiotracer

More information

Interventricular Septum Thickness Predicts Future Systolic Hypertension in Young Healthy Pilots

Interventricular Septum Thickness Predicts Future Systolic Hypertension in Young Healthy Pilots 15 Original Article Hypertens Res Vol.31 (2008) No.1 p.15-20 Interventricular Septum Thickness Predicts Future Systolic Hypertension in Young Healthy Pilots Chagai GROSSMAN 1), Alon GROSSMAN 2), Nira KOREN-MORAG

More information

BODY COMPOSITION (Why your weight isn't a good indication of health.)

BODY COMPOSITION (Why your weight isn't a good indication of health.) BODY COMPOSITION (Why your weight isn't a good indication of health.) Body Composition is the technical term used to describe the different components that, when taken together, make up a person's body

More information

Chapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence

Chapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence Chapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence 2.1 BMI and Breast Cancer Risk BMI is routinely used to qualify an individual s adiposity, yet it is simply a measure

More information

Does the reduction in systolic blood pressure alone explain the regression of left ventricular hypertrophy?

Does the reduction in systolic blood pressure alone explain the regression of left ventricular hypertrophy? (24) 18, S23 S28 & 24 Nature Publishing Group All rights reserved 95-92/4 $3. www.nature.com/jhh ORIGINAL ARTICLE Does the reduction in systolic blood pressure alone explain the regression of left ventricular

More information

Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients. Effect of Left Ventricular Mass Index Criteria

Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients. Effect of Left Ventricular Mass Index Criteria Original Article Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients. Effect of Left Ventricular Mass Index Criteria Eduardo Cantoni Rosa, Valdir Ambrósio Moysés, Ricardo Cintra Sesso,

More information

Bernhard L. Gerber. Differentiating HCM from athletes heart. Role of contrast enhanced MR.

Bernhard L. Gerber. Differentiating HCM from athletes heart. Role of contrast enhanced MR. Differentiating HCM from athletes heart. Role of contrast enhanced MR. Bernhard L. Gerber MD PhD FACC FESC Division of Cardiology Dpt. of Cardiovascular Diseases Cliniques Universitaires St.Luc UCL, Bruxelles

More information

Evaluation of Right Ventricular Function and Its Prognostic Value. Sarinya Puwanant, MD, FASE

Evaluation of Right Ventricular Function and Its Prognostic Value. Sarinya Puwanant, MD, FASE Evaluation of Right Ventricular Function and Its Prognostic Value Sarinya Puwanant, MD, FASE Scope Importance of the Right Ventricle Right Ventricular Anatomy Evaluation of Right Ventricular Function Scope

More information

ROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA

ROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA ROBERT C. PRITCHARD DIRECTOR MICHAEL O. FOSTER ASSISTANT DIR. SLEEP APNEA A Person is physically qualified to drive a motor vehicle if that person; -(5) has no established medical history or clinical diagnosis

More information

Sleep Disordered Breathing and HH with Preserved Ejection Fraction:

Sleep Disordered Breathing and HH with Preserved Ejection Fraction: Sleep Disordered Breathing and HH with Preserved Ejection Fraction: Pr Thibaud DAMY Heart Failure Unit Department of Cardiology CHU Mondor, Créteil, France Definition of HF-PEF The diagnosis of HF-PEF

More information

9/18/2017 DISCLOSURES. Consultant: RubiconMD. Research: Amgen, NHLBI OUTLINE OBJECTIVES. Review current CV risk assessment tools.

9/18/2017 DISCLOSURES. Consultant: RubiconMD. Research: Amgen, NHLBI OUTLINE OBJECTIVES. Review current CV risk assessment tools. UW MEDICINE UW MEDICINE UCSF ASIAN TITLE HEALTH OR EVENT SYMPOSIUM 2017 DISCLOSURES Consultant: RubiconMD ESTIMATING CV RISK IN ASIAN AMERICANS AND PREVENTION OF CVD Research: Amgen, NHLBI EUGENE YANG,

More information

Advances in Cardiovascular Arrhythmias - Great innovations in cardiology. Modulation of the ANS to prevent VT/VF

Advances in Cardiovascular Arrhythmias - Great innovations in cardiology. Modulation of the ANS to prevent VT/VF Advances in Cardiovascular Arrhythmias - Great innovations in cardiology Modulation of the ANS to prevent VT/VF Dominik Linz, MD, PhD Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische

More information

Clinical Indications for Echocardiography

Clinical Indications for Echocardiography Clinical Indications for Echocardiography Echocardiography is widely utilised and potential applications are increasing with advances in technology. The aim of this document is two-fold: 1) To define clinical

More information

Estrogens vs Testosterone for cardiovascular health and longevity

Estrogens vs Testosterone for cardiovascular health and longevity Estrogens vs Testosterone for cardiovascular health and longevity Panagiota Pietri, MD, PhD, FESC Director of Hypertension Unit Athens Medical Center Athens, Greece Women vs Men Is there a difference in

More information

Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm

Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm CASE REPORT Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm Mariana M. Floria 1, 4, Carmen Elena Pleșoianu 2, 4, Michel Buche 3, Baudouin Marchandise 4, Erwin

More information

Does Adding Examples to the American Society of Anesthesiologists Physical Status Classification Improve Consistency in Assignment to Patients?

Does Adding Examples to the American Society of Anesthesiologists Physical Status Classification Improve Consistency in Assignment to Patients? Does Adding Examples to the American Society of Anesthesiologists Physical Status Classification Improve Consistency in Assignment to Patients? Submitted Abstract to the 2015 ASA Annual Meeting 10 Hypothetical

More information

Hypertension, Remodelling and Novel Biomarkers in African Subjects

Hypertension, Remodelling and Novel Biomarkers in African Subjects Hypertension, Remodelling and Novel Biomarkers in African Subjects Dike Ojji MBBS, PhD, FWACP, FACP, FESC Senior Lecturer, Department of Medicine, Faculty of Health Sciences, University of Abuja & Honorary

More information

Cardiovascular Disease in CKD. Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center

Cardiovascular Disease in CKD. Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center Cardiovascular Disease in CKD Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center Objectives Describe prevalence for cardiovascular disease in CKD

More information

Prognostic significance of blood pressure measured on rising

Prognostic significance of blood pressure measured on rising (2001) 15, 413 417 2001 Nature Publishing Group All rights reserved 0950-9240/01 $15.00 www.nature.com/jhh ORIGINAL ARTICLE Prognostic significance of blood pressure measured on rising P Gosse, C Cipriano,

More information