Jayanth Koneru - Academia.edu (original) (raw)

Papers by Jayanth Koneru

Research paper thumbnail of Case Report ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens ’ Syndrome

Copyright © 2014 Kunal Patel et al. This is an open access article distributed under the Creative... more Copyright © 2014 Kunal Patel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Wellens ’ syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75 % of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent withWellens ’ syndrome that developed an acute anterior wall ST-elevati...

Research paper thumbnail of Rheumatoid Nodule Causing Perforation of Anterior Mitral Leaflet and Severe Mitral Regurgitation: A Rare Case Report

World Journal of Cardiovascular Diseases, 2014

Research paper thumbnail of Coronary anomaly and coronary artery fistula as cause of angina pectoris with literature review

Case reports in vascular medicine, 2011

Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause sym... more Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

Research paper thumbnail of 584 Prevalence of Severe PVD in a High-Risk Urban Population Receiving Self-Expanding Nitinol (Supera) Stents

Atherosclerosis Supplements, 2011

Research paper thumbnail of ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens’ Syndrome

Case Reports in Emergency Medicine, 2014

Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG ... more Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75% of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent with Wellens' syndrome that developed an acute anterior wall ST-elevation myocardial infarction after pharmacologic stress test.

Research paper thumbnail of Postpartum Coronary Vasospasm with Literature Review

Case Reports in Cardiology, 2014

Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case o... more Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

Research paper thumbnail of Interesting case of coronary artery fistula and coronary anomaly resulting in coronary steal with literature review

Journal of Clinical Medicine and Research, 2012

Coronary artery fistulae are rare and abnormal communications between a coronary artery and a gre... more Coronary artery fistulae are rare and abnormal communications between a coronary artery and a great vessel, which may shunt blood flow away from the myocardial capillary network causing steal phenomenon. We present a 47-year-old man with a unique arteriovenous fistula originating from the proximal portion of the left main coronary artery and entire left anterior descending artery, which then reconstitutes to form a branch of the left pulmonary artery.

Research paper thumbnail of Long-term effectiveness and safety of sirolimus drug-eluting stents

Medical Devices: Evidence and Research, 2011

The root cause of coronary artery disease is atherosclerosis, ie, intraluminal narrowing (stenosi... more The root cause of coronary artery disease is atherosclerosis, ie, intraluminal narrowing (stenosis) of the arteries that supply blood to tissues of the heart. The introduction of the drug-eluting stent over the past decade has revolutionized the field of interventional cardiology. It is used extensively in clinical practice for the treatment of coronary artery disease. The first drug-eluting stent to receive US Food and Drug Administration approval was the sirolimus-eluting stent. Recently, two other stent analogs of sirolimus were approved, ie, the zotarolimus-eluting stent and the everolimus-eluting stent. However, concern has arisen in recent years about the long-term safety and efficacy of drug-eluting stents, due to the occurrence of late adverse clinical events, such as stent thrombosis. This review focuses on clinical studies that have been performed with the sirolimus-eluting stent or its analogs. We discuss the pharmacology, safety, and various therapeutic options that exist when choosing stents for coronary artery disease. Our aim is to provide a thorough review of the long-term efficacy and safety of sirolimus drug-eluting stents, and also to discuss currently approved and promising investigational drug-eluting stents, in an effort to provide insight into how these stents are currently evolving and generate further investigation in this area.

Research paper thumbnail of Applicability, Limitations and Impact of Echocardiography Utilization Based on the 2007 Appropriateness Use Criteria for Transthoracic and Transesophageal Echocardiography at a Tertiary Care Medical Center

Journal of the American College of Cardiology, 2010

Research paper thumbnail of Predicting Prevalence of PAD in HIV Patients Combining ABI and Edinburgh Claudication Questionnaire

Research paper thumbnail of Renal Artery Stenosis in a Young Female without Fibromuscular Dysplasia with Literature Review

Clinical Medicine Insights: Cardiology, 2016

Renal artery stenosis (RAS) is rare in young patients without fibromuscular dysplasia (FMD). RAS ... more Renal artery stenosis (RAS) is rare in young patients without fibromuscular dysplasia (FMD). RAS is primarily classified as having two major etiologies, namely, atherosclerosis and FMD, with 90% and 10%, respectively. We report a case of a female in her mid 20s who developed hypertension due to RAS with no evidence of FMD or underlying renal dysfunction and underwent successful angioplasty and stenting.

Research paper thumbnail of Coronary anomaly and coronary artery fistula as cause of angina pectoris with literature review

Case reports in vascular medicine, 2011

Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause sym... more Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

Research paper thumbnail of 584 Prevalence of Severe PVD in a High-Risk Urban Population Receiving Self-Expanding Nitinol (Supera) Stents

Atherosclerosis Supplements, 2011

Research paper thumbnail of ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens’ Syndrome

Case Reports in Emergency Medicine, 2014

Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG ... more Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75% of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent with Wellens' syndrome that developed an acute anterior wall ST-elevation myocardial infarction after pharmacologic stress test.

Research paper thumbnail of Postpartum Coronary Vasospasm with Literature Review

Case Reports in Cardiology, 2014

Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case o... more Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

Research paper thumbnail of Interesting case of coronary artery fistula and coronary anomaly resulting in coronary steal with literature review

Journal of Clinical Medicine and Research, 2012

Coronary artery fistulae are rare and abnormal communications between a coronary artery and a gre... more Coronary artery fistulae are rare and abnormal communications between a coronary artery and a great vessel, which may shunt blood flow away from the myocardial capillary network causing steal phenomenon. We present a 47-year-old man with a unique arteriovenous fistula originating from the proximal portion of the left main coronary artery and entire left anterior descending artery, which then reconstitutes to form a branch of the left pulmonary artery.

Research paper thumbnail of Pre-Existing Left Ventricular Dysfunction in Patients Undergoing Kidney Transplantation: Implications for Patient Selection, Cardiac Risk Stratification and Impact on Post Transplant Outcomes

Journal of the American College of Cardiology, 2010

Category: Cardiomyopathies/Myocarditis/Pericardial Disease Objective: To determine graft and pati... more Category: Cardiomyopathies/Myocarditis/Pericardial Disease Objective: To determine graft and patient survival, rate of cardiac events (myocardial infarction, revascularization, or cardiac death) and hospitalization for congestive heart failure (CHF) in kidney transplant (KT) recipients with low left ventricular ejection fraction (EF) prior to transplantation.

Research paper thumbnail of Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging

Journal of Nuclear Cardiology, 2011

Background. There is increasing awareness of the value of phase analysis of gated tomographic myo... more Background. There is increasing awareness of the value of phase analysis of gated tomographic myocardial perfusion imaging in assessing left ventricular (LV) dyssynchrony. A concern repeatedly raised in many studies is whether reversible defects in the stress images ''ischemia'' could affect the phase-derived standard deviation and bandwidth, the two commonly used dyssynchrony indices. We hypothesized that the stress and rest images should provide comparable information because the images are acquired 1 hour after the tracer injection.

Research paper thumbnail of Prevalence, Determinants, and Clinical Significance of Cardiac Troponin-I Elevation in Individuals Admitted for a Hypertensive Emergency

The Journal of Clinical Hypertension, 2011

Hypertensive emergencies (HEs) are frequently accompanied with the release of cardiac troponin I ... more Hypertensive emergencies (HEs) are frequently accompanied with the release of cardiac troponin I (cTnI); however, determinants and clinical significance of cTnI elevation are largely unknown. A retrospective analysis was performed on patients (n = 567) with a diagnosis of HE admitted to two tertiary care centers that primarily serve an inner-city population. Data on demographics, clinical variables, and cTnI were collected through chart review. Using regression analyses, predictors of cTnI elevation were studied and the impact of cTnI on all-cause mortality (data obtained through the Social Security Death Index) was determined. cTnI elevation was observed in 186 (32.3%) admissions with a mean peak cTnI level of 4.06 ± 14.6 ng/mL. Predictors of cTnI were age, history of hypercholesterolemia, blood urea nitrogen level, pulmonary edema, and requirement for mechanical ventilation. During a mean follow-up period of 3.1 years, there were 211 deaths (37%). Neither the presence nor the extent of cTnI elevation was associated with mortality, while age, history of coronary artery disease, and blood urea nitrogen level were predictive of mortality. cTnI elevation commonly occurs in the setting of HEs. Despite a high incidence of adverse clinical outcomes, cTnI elevation was not an independent predictor of mortality in this population.

Research paper thumbnail of Applicability, limitations and downstream impact of echocardiography utilization based on the appropriateness use criteria for transthoracic and transesophageal echocardiography

The International Journal of Cardiovascular Imaging, 2012

To evaluate impact of echocardiography on patient management based on published transthoracic ech... more To evaluate impact of echocardiography on patient management based on published transthoracic echocardiography (TTE) Appropriate Use Criteria (AUC). A prospective analysis of 170 consecutive outpatients who underwent TTE over a period of 2 months. Echo studies were classified into appropriate (A), inappropriate (I), or uncertain (U) based on the 2007/2011 AUC. A fourth group of studies which were not addressed by the 2007 AUC and therefore have unclassifiable category (UC) were also included in the analysis. The impact of AUC categorized echo results on patient management were evaluated by review of patient records in the ensuing 2 months. Based on 2007 AUC, 77% (131/170) were A, 9% were I, and 14% were UC category. Echo studies classified as A were more likely to be associated with new and major findings, (P = 0.034) and (P = 0.028) respectively when compared to all other studies. Furthermore, patient care intervention as defined in the study protocol was significantly associated with A studies as opposed to I and UC studies (P = 0.004). A studies were also more likely to have an impact on patient management when compared to other studies (P = 0.022). When studies were re-evaluated based on the 2011 AUC, all prior UC studies were now included in the U group in the new AUC of 2011, and there was no change in A or I study classification. This study demonstrates that the 2007/2011 AUC are helpful in evaluating practice patterns in a majority of outpatients undergoing TTE. Implementing AUC have a direct clinical impact as A studies are significantly more likely to reveal new and major findings, and more likely to result in a patient care intervention based on the echo findings.

Research paper thumbnail of Case Report ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens ’ Syndrome

Copyright © 2014 Kunal Patel et al. This is an open access article distributed under the Creative... more Copyright © 2014 Kunal Patel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Wellens ’ syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75 % of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent withWellens ’ syndrome that developed an acute anterior wall ST-elevati...

Research paper thumbnail of Rheumatoid Nodule Causing Perforation of Anterior Mitral Leaflet and Severe Mitral Regurgitation: A Rare Case Report

World Journal of Cardiovascular Diseases, 2014

Research paper thumbnail of Coronary anomaly and coronary artery fistula as cause of angina pectoris with literature review

Case reports in vascular medicine, 2011

Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause sym... more Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

Research paper thumbnail of 584 Prevalence of Severe PVD in a High-Risk Urban Population Receiving Self-Expanding Nitinol (Supera) Stents

Atherosclerosis Supplements, 2011

Research paper thumbnail of ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens’ Syndrome

Case Reports in Emergency Medicine, 2014

Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG ... more Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75% of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent with Wellens' syndrome that developed an acute anterior wall ST-elevation myocardial infarction after pharmacologic stress test.

Research paper thumbnail of Postpartum Coronary Vasospasm with Literature Review

Case Reports in Cardiology, 2014

Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case o... more Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

Research paper thumbnail of Interesting case of coronary artery fistula and coronary anomaly resulting in coronary steal with literature review

Journal of Clinical Medicine and Research, 2012

Coronary artery fistulae are rare and abnormal communications between a coronary artery and a gre... more Coronary artery fistulae are rare and abnormal communications between a coronary artery and a great vessel, which may shunt blood flow away from the myocardial capillary network causing steal phenomenon. We present a 47-year-old man with a unique arteriovenous fistula originating from the proximal portion of the left main coronary artery and entire left anterior descending artery, which then reconstitutes to form a branch of the left pulmonary artery.

Research paper thumbnail of Long-term effectiveness and safety of sirolimus drug-eluting stents

Medical Devices: Evidence and Research, 2011

The root cause of coronary artery disease is atherosclerosis, ie, intraluminal narrowing (stenosi... more The root cause of coronary artery disease is atherosclerosis, ie, intraluminal narrowing (stenosis) of the arteries that supply blood to tissues of the heart. The introduction of the drug-eluting stent over the past decade has revolutionized the field of interventional cardiology. It is used extensively in clinical practice for the treatment of coronary artery disease. The first drug-eluting stent to receive US Food and Drug Administration approval was the sirolimus-eluting stent. Recently, two other stent analogs of sirolimus were approved, ie, the zotarolimus-eluting stent and the everolimus-eluting stent. However, concern has arisen in recent years about the long-term safety and efficacy of drug-eluting stents, due to the occurrence of late adverse clinical events, such as stent thrombosis. This review focuses on clinical studies that have been performed with the sirolimus-eluting stent or its analogs. We discuss the pharmacology, safety, and various therapeutic options that exist when choosing stents for coronary artery disease. Our aim is to provide a thorough review of the long-term efficacy and safety of sirolimus drug-eluting stents, and also to discuss currently approved and promising investigational drug-eluting stents, in an effort to provide insight into how these stents are currently evolving and generate further investigation in this area.

Research paper thumbnail of Applicability, Limitations and Impact of Echocardiography Utilization Based on the 2007 Appropriateness Use Criteria for Transthoracic and Transesophageal Echocardiography at a Tertiary Care Medical Center

Journal of the American College of Cardiology, 2010

Research paper thumbnail of Predicting Prevalence of PAD in HIV Patients Combining ABI and Edinburgh Claudication Questionnaire

Research paper thumbnail of Renal Artery Stenosis in a Young Female without Fibromuscular Dysplasia with Literature Review

Clinical Medicine Insights: Cardiology, 2016

Renal artery stenosis (RAS) is rare in young patients without fibromuscular dysplasia (FMD). RAS ... more Renal artery stenosis (RAS) is rare in young patients without fibromuscular dysplasia (FMD). RAS is primarily classified as having two major etiologies, namely, atherosclerosis and FMD, with 90% and 10%, respectively. We report a case of a female in her mid 20s who developed hypertension due to RAS with no evidence of FMD or underlying renal dysfunction and underwent successful angioplasty and stenting.

Research paper thumbnail of Coronary anomaly and coronary artery fistula as cause of angina pectoris with literature review

Case reports in vascular medicine, 2011

Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause sym... more Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

Research paper thumbnail of 584 Prevalence of Severe PVD in a High-Risk Urban Population Receiving Self-Expanding Nitinol (Supera) Stents

Atherosclerosis Supplements, 2011

Research paper thumbnail of ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens’ Syndrome

Case Reports in Emergency Medicine, 2014

Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG ... more Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75% of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent with Wellens' syndrome that developed an acute anterior wall ST-elevation myocardial infarction after pharmacologic stress test.

Research paper thumbnail of Postpartum Coronary Vasospasm with Literature Review

Case Reports in Cardiology, 2014

Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case o... more Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

Research paper thumbnail of Interesting case of coronary artery fistula and coronary anomaly resulting in coronary steal with literature review

Journal of Clinical Medicine and Research, 2012

Coronary artery fistulae are rare and abnormal communications between a coronary artery and a gre... more Coronary artery fistulae are rare and abnormal communications between a coronary artery and a great vessel, which may shunt blood flow away from the myocardial capillary network causing steal phenomenon. We present a 47-year-old man with a unique arteriovenous fistula originating from the proximal portion of the left main coronary artery and entire left anterior descending artery, which then reconstitutes to form a branch of the left pulmonary artery.

Research paper thumbnail of Pre-Existing Left Ventricular Dysfunction in Patients Undergoing Kidney Transplantation: Implications for Patient Selection, Cardiac Risk Stratification and Impact on Post Transplant Outcomes

Journal of the American College of Cardiology, 2010

Category: Cardiomyopathies/Myocarditis/Pericardial Disease Objective: To determine graft and pati... more Category: Cardiomyopathies/Myocarditis/Pericardial Disease Objective: To determine graft and patient survival, rate of cardiac events (myocardial infarction, revascularization, or cardiac death) and hospitalization for congestive heart failure (CHF) in kidney transplant (KT) recipients with low left ventricular ejection fraction (EF) prior to transplantation.

Research paper thumbnail of Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging

Journal of Nuclear Cardiology, 2011

Background. There is increasing awareness of the value of phase analysis of gated tomographic myo... more Background. There is increasing awareness of the value of phase analysis of gated tomographic myocardial perfusion imaging in assessing left ventricular (LV) dyssynchrony. A concern repeatedly raised in many studies is whether reversible defects in the stress images ''ischemia'' could affect the phase-derived standard deviation and bandwidth, the two commonly used dyssynchrony indices. We hypothesized that the stress and rest images should provide comparable information because the images are acquired 1 hour after the tracer injection.

Research paper thumbnail of Prevalence, Determinants, and Clinical Significance of Cardiac Troponin-I Elevation in Individuals Admitted for a Hypertensive Emergency

The Journal of Clinical Hypertension, 2011

Hypertensive emergencies (HEs) are frequently accompanied with the release of cardiac troponin I ... more Hypertensive emergencies (HEs) are frequently accompanied with the release of cardiac troponin I (cTnI); however, determinants and clinical significance of cTnI elevation are largely unknown. A retrospective analysis was performed on patients (n = 567) with a diagnosis of HE admitted to two tertiary care centers that primarily serve an inner-city population. Data on demographics, clinical variables, and cTnI were collected through chart review. Using regression analyses, predictors of cTnI elevation were studied and the impact of cTnI on all-cause mortality (data obtained through the Social Security Death Index) was determined. cTnI elevation was observed in 186 (32.3%) admissions with a mean peak cTnI level of 4.06 ± 14.6 ng/mL. Predictors of cTnI were age, history of hypercholesterolemia, blood urea nitrogen level, pulmonary edema, and requirement for mechanical ventilation. During a mean follow-up period of 3.1 years, there were 211 deaths (37%). Neither the presence nor the extent of cTnI elevation was associated with mortality, while age, history of coronary artery disease, and blood urea nitrogen level were predictive of mortality. cTnI elevation commonly occurs in the setting of HEs. Despite a high incidence of adverse clinical outcomes, cTnI elevation was not an independent predictor of mortality in this population.

Research paper thumbnail of Applicability, limitations and downstream impact of echocardiography utilization based on the appropriateness use criteria for transthoracic and transesophageal echocardiography

The International Journal of Cardiovascular Imaging, 2012

To evaluate impact of echocardiography on patient management based on published transthoracic ech... more To evaluate impact of echocardiography on patient management based on published transthoracic echocardiography (TTE) Appropriate Use Criteria (AUC). A prospective analysis of 170 consecutive outpatients who underwent TTE over a period of 2 months. Echo studies were classified into appropriate (A), inappropriate (I), or uncertain (U) based on the 2007/2011 AUC. A fourth group of studies which were not addressed by the 2007 AUC and therefore have unclassifiable category (UC) were also included in the analysis. The impact of AUC categorized echo results on patient management were evaluated by review of patient records in the ensuing 2 months. Based on 2007 AUC, 77% (131/170) were A, 9% were I, and 14% were UC category. Echo studies classified as A were more likely to be associated with new and major findings, (P = 0.034) and (P = 0.028) respectively when compared to all other studies. Furthermore, patient care intervention as defined in the study protocol was significantly associated with A studies as opposed to I and UC studies (P = 0.004). A studies were also more likely to have an impact on patient management when compared to other studies (P = 0.022). When studies were re-evaluated based on the 2011 AUC, all prior UC studies were now included in the U group in the new AUC of 2011, and there was no change in A or I study classification. This study demonstrates that the 2007/2011 AUC are helpful in evaluating practice patterns in a majority of outpatients undergoing TTE. Implementing AUC have a direct clinical impact as A studies are significantly more likely to reveal new and major findings, and more likely to result in a patient care intervention based on the echo findings.