Angel Lopez-candales - Academia.edu (original) (raw)

Papers by Angel Lopez-candales

Research paper thumbnail of Caseous Calcification: Now You See Me, Now You Don’t

Cureus

Thekekara et al. This is an open access article distributed under the terms of the Creative Commo... more Thekekara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Research paper thumbnail of An Unusual Culprit for Exertional Dyspnea

Research paper thumbnail of Electromechanical Dissociation and Paradoxical Embolization During Hip Surgery

Research paper thumbnail of Elevated Brain Natriuretic Peptide and Troponin I in a Woman with Generalized Weakness and Chest Pain

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Mar 1, 2005

We report the case of a female patient emergently transferred to our institution with the presump... more We report the case of a female patient emergently transferred to our institution with the presumptive diagnosis of myocardial infarction in heart failure given the constellation of symptoms and abnormal laboratory cardiac markers on presentation. However, on closer examination, prior to instituting an invasive cardiac work-up, pulmonary embolism was instead strongly considered to explain a common etiology. Therefore, an echocardiogram was promptly obtained, which revealed the presence of McConnell's sign. This noninvasive imaging modality proved to be critical in the prompt recognition and management of this patient. We reviewed the literature regarding the use of echocardiography and the clinical significance of abnormal cardiac markers in patients presenting pulmonary embolism.

Research paper thumbnail of Assessment of Mitral Annular and Velocity Vector Imaging in Acute Myopericarditis

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Jul 1, 2013

A 25-year-old student presenting with pleuritic chest pain, elevated troponin levels and subtle e... more A 25-year-old student presenting with pleuritic chest pain, elevated troponin levels and subtle electrocardiogram abnormalities was treated for presumptive myopericarditis. On echocardiography, a lower than expected mitral annular displacement and systolic velocity were identified along with abnormalities in left ventricular strain generation that matched areas of edema and necrosis by cardiac magnetic resonance imaging. The patient was treated with nonsteroidal antiinflammatory drugs and colchicine, and both the symptoms and echocardiographic abnormalities rapidly resolved. These novel findings suggest that changes in mitral annular displacement and systolic velocity occur in acute myopericarditis and may be useful in following the course of the disease.

Research paper thumbnail of Automated Functional Imaging for Assessment of Left Ventricular Mechanics in the Presence of Left Ventricular Hypertrophy

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Nov 26, 2013

Increased left ventricular (LV) mass is a well-known independent predictor of cardiovascular morb... more Increased left ventricular (LV) mass is a well-known independent predictor of cardiovascular morbidity and mortality. Even though these patients have an increased risk of LV diastolic dysfunction; recent data have suggested the presence of subtle LV systolic abnormalities. This study sought to demonstrate if a novel speckle tracking automated functional imaging (AFI) tool would be useful in identifying differences in strain generation between patients with normal and increased LV wall mass. Standard measures of LV systolic and diastolic function were collected from 90 patients divided into Group I with LV mass index <100 g/m(2) and Group II with LV mass index values ≥100 g/m(2). AFI was also obtained to measure peak global LV myocardial strain. As expected, patients with an increased LV mass index had significant LV diastolic abnormalities. However, in addition these patients in Group II not only had significantly lower peak systolic strain values but also significantly lower mitral annular plane systolic excursion (MAPSE) and MA tissue Doppler imaging systolic velocity values than patients in Group I despite having comparable estimates of LV ejection fraction, based on the Simpson's method. Based on these results, AFI provides prompt point of care information regarding LV function and mechanics and identifies differences in longitudinal strain generation between patients with normal and increased LV wall mass. Additional studies are now required to prospectively determine if AFI measures of LV function might be useful to identify patients with an increased LV mass that will develop symptomatic systolic or diastolic heart failure.

Research paper thumbnail of Improving diagnostic assessments in the ever-changing landscape of atherosclerosis

Journal of Cardiovascular Medicine

As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagno... more As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagnostic approaches. Emerging data have recently challenged our basic understanding in linking ischemia to its adverse outcomes as well as the need for invasive testing for both diagnosis and treatment. The advent of coronary computed tomography in providing improved visualization of coronary arteries has led to the identification of both subclinical atherosclerosis and high-risk coronary lesions. Recognition of asymptomatic coronary artery disease (CAD) with objective localization of subclinical coronary atherosclerosis improves atherosclerotic cardiovascular risk assessment and allows healthcare providers to take effective primary prevention measures. Therefore, reshaping the diagnostic landscape in proposing new testing modalities would be highly dependent on local resource availability and the reading expertise of each clinical practice and medical institution. The main objective of this...

Research paper thumbnail of Therapeutic advances in guideline‐directed medical therapy for heart failure: the idealistic versus the pragmatic truth for vulnerable patients

Research paper thumbnail of Abstract 188: Ischemic Heart Disease Burden On Clinical Outcomes After Percutaneous Left Atrial Appendage Closure In Patients With Atrial Fibrillation In The United States

Circulation: Cardiovascular Quality and Outcomes

Background: Percutaneous left atrial appendage closure (PLAAC) is an alternative to anticoagulant... more Background: Percutaneous left atrial appendage closure (PLAAC) is an alternative to anticoagulants for atrial fibrillation patients with elevated stroke risk and contraindication to anticoagulation. We examined the burden of IHD on clinical outcomes after PLAAC. Methods: We identified patients from the Nationwide Readmission Database who underwent PLAAC with a Watchman device between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of IHD. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Multivariable regression was conducted for 30 days readmission adjusting for patient demographics,hospital characteristics, and Elixhauser Comorbidity Index. Results: A total of 18,348 Watchman recipients were identified, of which 8,504 had IHD while 9,844 had no ischemic heart disease (NIHD). Length of stay and cost were not different between groups. However, significant differences were noted in te...

Research paper thumbnail of PO-665-05 Gender Stratified Analysis: Post Atrial Fibrillation (Af) Ablation Outcomesreal World Data

Research paper thumbnail of Abstract 14581: Impact of Heart Failure on 30-day Readmissions After Transcatheter Left Atrial Appendage Occlusion With the Watchman Device

Circulation

Background: The Watchman device reduces the risk of stroke in select patients with atrial fibrill... more Background: The Watchman device reduces the risk of stroke in select patients with atrial fibrillation (AF). AF commonly coexists with heart failure (HF) and these conditions harbor interrelated pathophysiological mechanisms and treatment strategies., the impact of comorbid heart failure on outcomes in patients with AF undergoing Watchman device implantation remains unclear. Methods: We identified patients from the Nationwide Readmission Database who underwent Watchman device placement between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of HF. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Kaplan-Meier analysis was used to assess the association of HF with 30-day hospital readmission. Results: We identified 18,349 recipients, 13,180 had no heart failure (NHF) while 5169 had HF. Mean age was similar between both groups. A total of 789 (5.9%) were readmitted within 30 days in th...

Research paper thumbnail of Subclinical Right Ventricular Dysfunction in Patients with Severe Aortic Stenosis: A Retrospective Case Series

<b>Article full text</b> <br> The full text of this article can be found here&l... more <b>Article full text</b> <br> The full text of this article can be found here<b>. </b>https://link.springer.com/article/10.1007/s40119-017-0084-8 <br> <b>Provide enhanced content for this article</b> <br> If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <b>adisrapidplus@springer.com</b>. <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as 'peer reviewed' to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content. <br> Other enhanced features include, but are not limited to: <br> • Slide decks • Videos and animations • Audio abstracts • Audio slides

Research paper thumbnail of Kounis syndrome: A more commonly encountered cause of acute coronary syndrome

Heart Views, 2019

Kounis syndrome (KS) has been defined as cardiovascular symptoms that occur secondary to allergic... more Kounis syndrome (KS) has been defined as cardiovascular symptoms that occur secondary to allergic or hypersensitivity insults. It was thought to be a rare condition but is now being more commonly identified as the cause of acute coronary events in patients without previous history of coronary artery disease (CAD). The most identified KS cases have been provoked by medications on elderly male patients. The purpose of this case report is to describe an unusual case of KS, triggered by a food allergen in a young female patient. This case reminds us that it is important to have a high index of suspicion, particularly in MI patients presenting without previous history of CAD. In this manner, an appropriate management, considering both cardiac and allergic components of KS, can be given without further delay and progression of symptoms.

Research paper thumbnail of 3321 European Ancestry as a Risk Factor for Atrial Fibrillation in Puerto Rican Hispanics

Journal of Clinical and Translational Science, 2019

OBJECTIVES/SPECIFIC AIMS: Consequently, we have decided to evaluate the presence of single nucleo... more OBJECTIVES/SPECIFIC AIMS: Consequently, we have decided to evaluate the presence of single nucleotide polymorphism (SNP) previously associated with AF on a European-descent population in an attempt to first identify the most common loci present in the PRH population and then search for specific PRH SNP associated with AF. METHODS/STUDY POPULATION: A secondary analysis of a Puerto Rican population sample (n = 120) from The Pharmacogenetics of Warfarin in Puerto Ricans Study will be performed. We will implement data from the 1000 genome project to establish a control group of healthy PRH population. Will evaluate the presence of 111 known single nucleotide polymorphisms associated with AF in Europeans and determine the frequency in PRH population sample, and validate predictability of such SNPs. Using admixture informatic markers (AIM) analysis will determine the percentage of admixture by Yoruba, Native American and Iberic-European. Statistical analysis will include the use of the Pe...

Research paper thumbnail of Heart failure readmissions: a losing battle or an opportunity for improvement?

Postgraduate Medicine, 2019

Despite great strides in diagnosis and management of heart failure (HF), this chronic illness con... more Despite great strides in diagnosis and management of heart failure (HF), this chronic illness continues to be a worldwide epidemic with approximately 23 million people afflicted across the globe. In the US, over 6.5 million carry a HF diagnosis with almost 90% of all HF deaths occurring in patients over the age of 70. Since one in five Americans are expected to be older than 65 years by 2050, almost 1,000,000 new HF cases are expected to be diagnosed every year. The staggering nature of these numbers only pales in comparison to current dismal HF survival statistics. The unavoidable natural history of HF continues to be characterized by the occurrence of repetitive hospital admissions. Not only are hospital readmissions demarcated as one of the most important risk factors associated with mortality; but also, a well-recognized trigger for additional hospital readmissions. Even when HF treatment guidelines have been recently updated; the mere fact that four HF societies have issued individual recommendations without reaching a common unifying consensus statement adds to the complexity of HF patient management. The purpose of this Editorial not only to fuel more interest on this topic but also to spark the notion that we have a potential catastrophe in our hands and is the responsibility of all health-care professionals to attend to this vital issue.

Research paper thumbnail of Dynamic Piston Function of the Mitral Annulus to Assess Early Left Ventricular Diastolic Filling: A Proof of Concept Study

Cardiology and Therapy, 2019

Introduction: Early left ventricular (LV) filling has been described as an asymmetric toroidal vo... more Introduction: Early left ventricular (LV) filling has been described as an asymmetric toroidal vortex ring of blood entering the LV upon opening of the mitral valve. This phenomenon is in part responsible for cyclical changes in LV volumes during the cardiac cycle and also contributes to the apical and basal longitudinal displacements of the mitral annulus (MA). Although MA early diastolic (e') velocities have been used to assess early LV filling characteristics, accurate distinction between normal aging and pathological diastolic dysfunction (DD) might be challenging at times. Methods: In this pilot study, echocardiographic data from 60 consecutive patients were reviewed. The studied population was allocated into three groups based on the new American Society of Echocardiography guidelines for diastolic dysfunction classification. To better

Research paper thumbnail of Beyond the new blood pressure guidelines: the beat goes on

Postgraduate Medicine, 2018

The scope of hypertension (HTN) even for those involved in the field is staggering with numbers c... more The scope of hypertension (HTN) even for those involved in the field is staggering with numbers close to 60 million Americans and more than 1 billion individuals across the globe. It is the most common reason to seek medical attention and according to the World Health Organization, the number one cause of mortality in the world. Yet, we still don't know what is normal or abnormal. Even though the most recent 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults has created quite a commotion, new questions could be raised. The purpose of this Editorial not only to fuel more interest on this topic but also to create the notion that HTN needs to be considered a dynamic clinical entity rather than a static blood pressure reading.

Research paper thumbnail of Are objective measures of tricuspid annular motion and velocity used as frequently as recommended by current guidelines? A pilot study

Indian Heart Journal, 2017

In this retrospective study 420 echocardiograms from a single center were reviewed showing that T... more In this retrospective study 420 echocardiograms from a single center were reviewed showing that TAPSE was acquired in 66% while TA TDI s' signals were recorded in 98% of all echocardiograms. Based on these results greater efforts are required to standardize acquisition and reporting of objective measurements of RV function.

Research paper thumbnail of Is mitral annular ascent useful in studying left ventricular function through left atrio-ventricular interactions?

Indian Heart Journal, 2017

Background: The mitral annulus (MA) is a crucial structure that is in constant motion throughout ... more Background: The mitral annulus (MA) is a crucial structure that is in constant motion throughout the cardiac cycle. The main purpose of this study was to determine if M-mode evaluation of the longitudinal motion of the MA could be useful to examine atrio-ventricular interactions. Methods: Echocardiographic data obtained from 150 patients (mean age 56 AE 16; 82 males) from the University of Cincinnati College of Medicine was evaluated to examine if any relationship exists between MA motion and measures of atrio-ventricular interactions. Results: Even though left atrial size, left ventricular (LV) mass index, LV ejection fraction (LVEF) and degree of LV diastolic dysfunction (LVDD) were significant echocardiographic variables affecting MA motion; LVEF and the degree of LVDD were the main determinants of MA excursion during systole (MAPSE) and after atrial contraction (MAa). Our results confirm the surrogate value of MAPSE with regards to LVEF and also show that the extent of MA excursion during systole is the main determinant of MAa. The effect of LV diastolic function applies more strongly to MAPSE than to MAa. However, the maximal MAa amplitude varies in accordance to the type of LVDD. Conclusions: We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.

Research paper thumbnail of Changes in Mitral Annular Ascent with Worsening Echocardiographic Parameters of Left Ventricular Diastolic Function

Scientifica, 2016

Background. While the mitral annular plane systolic excursion (MAPSE) has been suggested as a sur... more Background. While the mitral annular plane systolic excursion (MAPSE) has been suggested as a surrogate measurement of left ventricular ejection fraction, less is known about the relative value of mitral annular ascent (MAa).Methods. Our database was queried for complete transthoracic echocardiograms performed for any clinical indication. Baseline echocardiographic measurements were compared to determine any correlation between MAa and traditional Echo-Doppler echocardiographic measures to characterize left ventricular diastolic dysfunction (LVDD).Results. Patients with normal LV diastolic function were younger (41±13years) than patients with LVDD (stage 1:61±13years; stage 2:57±14years; and stage 3:66±17years;p=0.156). LV ejection fraction decreased in patients with stage 2 LVDD (63±17%) and was further reduced in patients with stage 3 LVDD (28±21;p=0.003).Discussion. While a vigorous MAa excursion was seen in patients with stage 1 LVDD, MAa significantly decreased in stage 2 and s...

Research paper thumbnail of Caseous Calcification: Now You See Me, Now You Don’t

Cureus

Thekekara et al. This is an open access article distributed under the terms of the Creative Commo... more Thekekara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Research paper thumbnail of An Unusual Culprit for Exertional Dyspnea

Research paper thumbnail of Electromechanical Dissociation and Paradoxical Embolization During Hip Surgery

Research paper thumbnail of Elevated Brain Natriuretic Peptide and Troponin I in a Woman with Generalized Weakness and Chest Pain

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Mar 1, 2005

We report the case of a female patient emergently transferred to our institution with the presump... more We report the case of a female patient emergently transferred to our institution with the presumptive diagnosis of myocardial infarction in heart failure given the constellation of symptoms and abnormal laboratory cardiac markers on presentation. However, on closer examination, prior to instituting an invasive cardiac work-up, pulmonary embolism was instead strongly considered to explain a common etiology. Therefore, an echocardiogram was promptly obtained, which revealed the presence of McConnell&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sign. This noninvasive imaging modality proved to be critical in the prompt recognition and management of this patient. We reviewed the literature regarding the use of echocardiography and the clinical significance of abnormal cardiac markers in patients presenting pulmonary embolism.

Research paper thumbnail of Assessment of Mitral Annular and Velocity Vector Imaging in Acute Myopericarditis

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Jul 1, 2013

A 25-year-old student presenting with pleuritic chest pain, elevated troponin levels and subtle e... more A 25-year-old student presenting with pleuritic chest pain, elevated troponin levels and subtle electrocardiogram abnormalities was treated for presumptive myopericarditis. On echocardiography, a lower than expected mitral annular displacement and systolic velocity were identified along with abnormalities in left ventricular strain generation that matched areas of edema and necrosis by cardiac magnetic resonance imaging. The patient was treated with nonsteroidal antiinflammatory drugs and colchicine, and both the symptoms and echocardiographic abnormalities rapidly resolved. These novel findings suggest that changes in mitral annular displacement and systolic velocity occur in acute myopericarditis and may be useful in following the course of the disease.

Research paper thumbnail of Automated Functional Imaging for Assessment of Left Ventricular Mechanics in the Presence of Left Ventricular Hypertrophy

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Nov 26, 2013

Increased left ventricular (LV) mass is a well-known independent predictor of cardiovascular morb... more Increased left ventricular (LV) mass is a well-known independent predictor of cardiovascular morbidity and mortality. Even though these patients have an increased risk of LV diastolic dysfunction; recent data have suggested the presence of subtle LV systolic abnormalities. This study sought to demonstrate if a novel speckle tracking automated functional imaging (AFI) tool would be useful in identifying differences in strain generation between patients with normal and increased LV wall mass. Standard measures of LV systolic and diastolic function were collected from 90 patients divided into Group I with LV mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;100 g/m(2) and Group II with LV mass index values ≥100 g/m(2). AFI was also obtained to measure peak global LV myocardial strain. As expected, patients with an increased LV mass index had significant LV diastolic abnormalities. However, in addition these patients in Group II not only had significantly lower peak systolic strain values but also significantly lower mitral annular plane systolic excursion (MAPSE) and MA tissue Doppler imaging systolic velocity values than patients in Group I despite having comparable estimates of LV ejection fraction, based on the Simpson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s method. Based on these results, AFI provides prompt point of care information regarding LV function and mechanics and identifies differences in longitudinal strain generation between patients with normal and increased LV wall mass. Additional studies are now required to prospectively determine if AFI measures of LV function might be useful to identify patients with an increased LV mass that will develop symptomatic systolic or diastolic heart failure.

Research paper thumbnail of Improving diagnostic assessments in the ever-changing landscape of atherosclerosis

Journal of Cardiovascular Medicine

As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagno... more As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagnostic approaches. Emerging data have recently challenged our basic understanding in linking ischemia to its adverse outcomes as well as the need for invasive testing for both diagnosis and treatment. The advent of coronary computed tomography in providing improved visualization of coronary arteries has led to the identification of both subclinical atherosclerosis and high-risk coronary lesions. Recognition of asymptomatic coronary artery disease (CAD) with objective localization of subclinical coronary atherosclerosis improves atherosclerotic cardiovascular risk assessment and allows healthcare providers to take effective primary prevention measures. Therefore, reshaping the diagnostic landscape in proposing new testing modalities would be highly dependent on local resource availability and the reading expertise of each clinical practice and medical institution. The main objective of this...

Research paper thumbnail of Therapeutic advances in guideline‐directed medical therapy for heart failure: the idealistic versus the pragmatic truth for vulnerable patients

Research paper thumbnail of Abstract 188: Ischemic Heart Disease Burden On Clinical Outcomes After Percutaneous Left Atrial Appendage Closure In Patients With Atrial Fibrillation In The United States

Circulation: Cardiovascular Quality and Outcomes

Background: Percutaneous left atrial appendage closure (PLAAC) is an alternative to anticoagulant... more Background: Percutaneous left atrial appendage closure (PLAAC) is an alternative to anticoagulants for atrial fibrillation patients with elevated stroke risk and contraindication to anticoagulation. We examined the burden of IHD on clinical outcomes after PLAAC. Methods: We identified patients from the Nationwide Readmission Database who underwent PLAAC with a Watchman device between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of IHD. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Multivariable regression was conducted for 30 days readmission adjusting for patient demographics,hospital characteristics, and Elixhauser Comorbidity Index. Results: A total of 18,348 Watchman recipients were identified, of which 8,504 had IHD while 9,844 had no ischemic heart disease (NIHD). Length of stay and cost were not different between groups. However, significant differences were noted in te...

Research paper thumbnail of PO-665-05 Gender Stratified Analysis: Post Atrial Fibrillation (Af) Ablation Outcomesreal World Data

Research paper thumbnail of Abstract 14581: Impact of Heart Failure on 30-day Readmissions After Transcatheter Left Atrial Appendage Occlusion With the Watchman Device

Circulation

Background: The Watchman device reduces the risk of stroke in select patients with atrial fibrill... more Background: The Watchman device reduces the risk of stroke in select patients with atrial fibrillation (AF). AF commonly coexists with heart failure (HF) and these conditions harbor interrelated pathophysiological mechanisms and treatment strategies., the impact of comorbid heart failure on outcomes in patients with AF undergoing Watchman device implantation remains unclear. Methods: We identified patients from the Nationwide Readmission Database who underwent Watchman device placement between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of HF. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Kaplan-Meier analysis was used to assess the association of HF with 30-day hospital readmission. Results: We identified 18,349 recipients, 13,180 had no heart failure (NHF) while 5169 had HF. Mean age was similar between both groups. A total of 789 (5.9%) were readmitted within 30 days in th...

Research paper thumbnail of Subclinical Right Ventricular Dysfunction in Patients with Severe Aortic Stenosis: A Retrospective Case Series

<b>Article full text</b> <br> The full text of this article can be found here&l... more <b>Article full text</b> <br> The full text of this article can be found here<b>. </b>https://link.springer.com/article/10.1007/s40119-017-0084-8 <br> <b>Provide enhanced content for this article</b> <br> If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <b>adisrapidplus@springer.com</b>. <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as 'peer reviewed' to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content. <br> Other enhanced features include, but are not limited to: <br> • Slide decks • Videos and animations • Audio abstracts • Audio slides

Research paper thumbnail of Kounis syndrome: A more commonly encountered cause of acute coronary syndrome

Heart Views, 2019

Kounis syndrome (KS) has been defined as cardiovascular symptoms that occur secondary to allergic... more Kounis syndrome (KS) has been defined as cardiovascular symptoms that occur secondary to allergic or hypersensitivity insults. It was thought to be a rare condition but is now being more commonly identified as the cause of acute coronary events in patients without previous history of coronary artery disease (CAD). The most identified KS cases have been provoked by medications on elderly male patients. The purpose of this case report is to describe an unusual case of KS, triggered by a food allergen in a young female patient. This case reminds us that it is important to have a high index of suspicion, particularly in MI patients presenting without previous history of CAD. In this manner, an appropriate management, considering both cardiac and allergic components of KS, can be given without further delay and progression of symptoms.

Research paper thumbnail of 3321 European Ancestry as a Risk Factor for Atrial Fibrillation in Puerto Rican Hispanics

Journal of Clinical and Translational Science, 2019

OBJECTIVES/SPECIFIC AIMS: Consequently, we have decided to evaluate the presence of single nucleo... more OBJECTIVES/SPECIFIC AIMS: Consequently, we have decided to evaluate the presence of single nucleotide polymorphism (SNP) previously associated with AF on a European-descent population in an attempt to first identify the most common loci present in the PRH population and then search for specific PRH SNP associated with AF. METHODS/STUDY POPULATION: A secondary analysis of a Puerto Rican population sample (n = 120) from The Pharmacogenetics of Warfarin in Puerto Ricans Study will be performed. We will implement data from the 1000 genome project to establish a control group of healthy PRH population. Will evaluate the presence of 111 known single nucleotide polymorphisms associated with AF in Europeans and determine the frequency in PRH population sample, and validate predictability of such SNPs. Using admixture informatic markers (AIM) analysis will determine the percentage of admixture by Yoruba, Native American and Iberic-European. Statistical analysis will include the use of the Pe...

Research paper thumbnail of Heart failure readmissions: a losing battle or an opportunity for improvement?

Postgraduate Medicine, 2019

Despite great strides in diagnosis and management of heart failure (HF), this chronic illness con... more Despite great strides in diagnosis and management of heart failure (HF), this chronic illness continues to be a worldwide epidemic with approximately 23 million people afflicted across the globe. In the US, over 6.5 million carry a HF diagnosis with almost 90% of all HF deaths occurring in patients over the age of 70. Since one in five Americans are expected to be older than 65 years by 2050, almost 1,000,000 new HF cases are expected to be diagnosed every year. The staggering nature of these numbers only pales in comparison to current dismal HF survival statistics. The unavoidable natural history of HF continues to be characterized by the occurrence of repetitive hospital admissions. Not only are hospital readmissions demarcated as one of the most important risk factors associated with mortality; but also, a well-recognized trigger for additional hospital readmissions. Even when HF treatment guidelines have been recently updated; the mere fact that four HF societies have issued individual recommendations without reaching a common unifying consensus statement adds to the complexity of HF patient management. The purpose of this Editorial not only to fuel more interest on this topic but also to spark the notion that we have a potential catastrophe in our hands and is the responsibility of all health-care professionals to attend to this vital issue.

Research paper thumbnail of Dynamic Piston Function of the Mitral Annulus to Assess Early Left Ventricular Diastolic Filling: A Proof of Concept Study

Cardiology and Therapy, 2019

Introduction: Early left ventricular (LV) filling has been described as an asymmetric toroidal vo... more Introduction: Early left ventricular (LV) filling has been described as an asymmetric toroidal vortex ring of blood entering the LV upon opening of the mitral valve. This phenomenon is in part responsible for cyclical changes in LV volumes during the cardiac cycle and also contributes to the apical and basal longitudinal displacements of the mitral annulus (MA). Although MA early diastolic (e') velocities have been used to assess early LV filling characteristics, accurate distinction between normal aging and pathological diastolic dysfunction (DD) might be challenging at times. Methods: In this pilot study, echocardiographic data from 60 consecutive patients were reviewed. The studied population was allocated into three groups based on the new American Society of Echocardiography guidelines for diastolic dysfunction classification. To better

Research paper thumbnail of Beyond the new blood pressure guidelines: the beat goes on

Postgraduate Medicine, 2018

The scope of hypertension (HTN) even for those involved in the field is staggering with numbers c... more The scope of hypertension (HTN) even for those involved in the field is staggering with numbers close to 60 million Americans and more than 1 billion individuals across the globe. It is the most common reason to seek medical attention and according to the World Health Organization, the number one cause of mortality in the world. Yet, we still don't know what is normal or abnormal. Even though the most recent 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults has created quite a commotion, new questions could be raised. The purpose of this Editorial not only to fuel more interest on this topic but also to create the notion that HTN needs to be considered a dynamic clinical entity rather than a static blood pressure reading.

Research paper thumbnail of Are objective measures of tricuspid annular motion and velocity used as frequently as recommended by current guidelines? A pilot study

Indian Heart Journal, 2017

In this retrospective study 420 echocardiograms from a single center were reviewed showing that T... more In this retrospective study 420 echocardiograms from a single center were reviewed showing that TAPSE was acquired in 66% while TA TDI s' signals were recorded in 98% of all echocardiograms. Based on these results greater efforts are required to standardize acquisition and reporting of objective measurements of RV function.

Research paper thumbnail of Is mitral annular ascent useful in studying left ventricular function through left atrio-ventricular interactions?

Indian Heart Journal, 2017

Background: The mitral annulus (MA) is a crucial structure that is in constant motion throughout ... more Background: The mitral annulus (MA) is a crucial structure that is in constant motion throughout the cardiac cycle. The main purpose of this study was to determine if M-mode evaluation of the longitudinal motion of the MA could be useful to examine atrio-ventricular interactions. Methods: Echocardiographic data obtained from 150 patients (mean age 56 AE 16; 82 males) from the University of Cincinnati College of Medicine was evaluated to examine if any relationship exists between MA motion and measures of atrio-ventricular interactions. Results: Even though left atrial size, left ventricular (LV) mass index, LV ejection fraction (LVEF) and degree of LV diastolic dysfunction (LVDD) were significant echocardiographic variables affecting MA motion; LVEF and the degree of LVDD were the main determinants of MA excursion during systole (MAPSE) and after atrial contraction (MAa). Our results confirm the surrogate value of MAPSE with regards to LVEF and also show that the extent of MA excursion during systole is the main determinant of MAa. The effect of LV diastolic function applies more strongly to MAPSE than to MAa. However, the maximal MAa amplitude varies in accordance to the type of LVDD. Conclusions: We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.

Research paper thumbnail of Changes in Mitral Annular Ascent with Worsening Echocardiographic Parameters of Left Ventricular Diastolic Function

Scientifica, 2016

Background. While the mitral annular plane systolic excursion (MAPSE) has been suggested as a sur... more Background. While the mitral annular plane systolic excursion (MAPSE) has been suggested as a surrogate measurement of left ventricular ejection fraction, less is known about the relative value of mitral annular ascent (MAa).Methods. Our database was queried for complete transthoracic echocardiograms performed for any clinical indication. Baseline echocardiographic measurements were compared to determine any correlation between MAa and traditional Echo-Doppler echocardiographic measures to characterize left ventricular diastolic dysfunction (LVDD).Results. Patients with normal LV diastolic function were younger (41±13years) than patients with LVDD (stage 1:61±13years; stage 2:57±14years; and stage 3:66±17years;p=0.156). LV ejection fraction decreased in patients with stage 2 LVDD (63±17%) and was further reduced in patients with stage 3 LVDD (28±21;p=0.003).Discussion. While a vigorous MAa excursion was seen in patients with stage 1 LVDD, MAa significantly decreased in stage 2 and s...