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Papers by Micah Eimer

The Joint Commission Journal on Quality and Patient Safety, 2022

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Current Treatment Options in Cardiovascular Medicine, 2021

Purpose of Review The COVID-19 pandemic has had a profound impact on athletics, and the question ... more Purpose of Review The COVID-19 pandemic has had a profound impact on athletics, and the question of safely resuming competitive sports at all levels has been a source of significant debate. Concerns regarding myocarditis and the risk of arrhythmias and sudden death in athletes have prompted heightened attention to the role of cardiovascular screening. In this review, we aim to comprehensively outline the cardiovascular manifestations associated with COVID-19 infection, to discuss screening, diagnosis, and treatment strategies, and to evaluate the current literature on the risk to athletes and recommendations regarding return-to-play. Recent Findings COVID-19 is known to cause myocarditis, with presentations ranging from subclinical current or prior infection detected on cardiac MRI imaging, to fulminant heart failure and shock. While initial data early in the pandemic suggested that the risk of myocarditis could be significant even in patients with nonsevere COVID-19 infection, recent studies suggest a very low prevalence of clinically significant disease in young athletes. Summary While COVID-19 can have significant cardiovascular manifestations, recent data demonstrate that a screening approach guided by severity of COVID-19 infection and cardiovascular symptoms allows the majority of athletes to safely return to play in a timely manner. We must continue to tailor our approach to screening athletes as knowledge grows, and further research on the longitudinal cardiovascular effects of COVID-19 is needed.

JAMA Cardiology, 2021

; for the Big Ten COVID-19 Cardiac Registry Investigators IMPORTANCE Myocarditis is a leading cau... more ; for the Big Ten COVID-19 Cardiac Registry Investigators IMPORTANCE Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches. OBJECTIVE To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play.

Journal of the American College of Cardiology, 2016

Background: Pre-participation electrocardiographic (ECG) screening is a very sensitive approach t... more Background: Pre-participation electrocardiographic (ECG) screening is a very sensitive approach to detecting abnormalities conferring risk for sudden cardiac death. Because training alters the ECG, athlete-specific criteria such as the Seattle criteria have been developed to reduce the false discovery rate. Emerging data regarding Seattle criteria demonstrate a higher false discovery rate in black athletes than white athletes. Furthermore, gender differences in Seattle criteria performance are not well described. Objective: To characterize the positive predictive value of ECGs read by Seattle criteria for cardiovascular abnormalities in a large, multiethnic cross-section of athletes at an NCAA Division I program. Methods: In 2014 and 2015, 712 collegiate athletes (353 males, 359 females, average age 20) were evaluated by history, physical examination, 12-lead ECG, and further follow-up testing as needed. ECGs were analyzed according to Seattle Criteria. Positive rates by race and gender were determined; Fisher's exact test was used to compute significance. Results: Of 712 athletes screened, Seattle criteria were positive in 28 (3.9%). Positive ECGs were found in 12/109 (11.0%) black athletes and 16/562 (2.8%) white athletes (P < 0.001). In athletes of other races, 0/41 (0%) ECGs were positive. By race and gender, 11/255 (4.3%) white males, 5/307 (1.6%) white females, 6/86 (6.9%) black males, and 6/23 (26%) black females had positive findings. Compared to gender matched controls, black male athletes had a 2.4x (P < 0.05), and black female athletes had a 16.3x (P < 0.0001) relative risk of an abnormal ECG by Seattle criteria. Downstream testing disclosed bicuspid aortic valve in one white male athlete. Thus in this cohort, the positive predictive value of ECG screening by Seattle criteria was 1/28 (3.5%), for a false discovery rate of 96.4%. Conclusions: In this cohort, positive rates for ECGs were higher in black athletes compared to white athletes, and the overall positive predictive value of ECG screening by Seattle Criteria was low. High rates of ECG abnormalities were found in black female athletes. Subanalyses in other published cohorts can confirm if this finding is robust.

Current Atherosclerosis Reports, 2004

Management of Heart Failure

ABSTRACT This chapter outlines the practical, initial 24 h of management in patients with acute h... more ABSTRACT This chapter outlines the practical, initial 24 h of management in patients with acute heart failure syndromes (AHFS). In the United States, emergency department (ED) physicians and internists provide the majority of management.

Journal of the American College of Cardiology, 2003

B-Type Natriuretic Peptide Predicts Lefi Ventricular Response to Surgery in Patients With Severe ... more B-Type Natriuretic Peptide Predicts Lefi Ventricular Response to Surgery in Patients With Severe Mitral Regurgitation in Asymptomatic Patients With Preserved Left Ventricular Function Conlusions: NT-proBNP was closely linked to severity of aortic stenosis and therefor may be usefull for therapeutical decision making.

Journal of the American College of Cardiology, 2002

The Journal of the American Board of Family Medicine, 1998

The Journal of Pediatrics, 2011

Objective-A pilot study of adults who had onset of juvenile dermatomyositis (JDM) in childhood, b... more Objective-A pilot study of adults who had onset of juvenile dermatomyositis (JDM) in childhood, before current therapeutic approaches, to characterize JDM symptoms and subclinical cardiovascular disease. Study design-Eight adults who had JDM assessed for disease activity and 8 healthy adults (cardiovascular disease controls) were tested for carotid intima media thickness and brachial arterial reactivity. Adults who had JDM and 16 age-, sex-, and body mass index-matched healthy metabolic controls were evaluated for body composition, blood pressure, fasting glucose, lipids, insulin resistance, leptin, adiponectin, proinflammatory oxidized high-density lipoprotein (HDL), and nail-fold capillary end row loops. Results-Adults with a history of JDM, median age 38 years (24-44 years) enrolled a median 29 years (9-38 years) after disease onset, had elevated disease activity scores, skin (7/8), muscle (4/8), and creatine phosphokinase (2/8). Compared with cardiovascular disease controls, adults who had JDM were younger, had lower body mass index and HDL cholesterol (P = .002), and increased intima media thickness (P = .015) and their brachial arterial reactivity suggested impairment of endothelial cell function. Compared with metabolic controls, adults who had JDM had higher systolic and diastolic blood pressure, P = .

Journal of Nuclear Cardiology, 2007

Annals of Internal Medicine, 2011

A major challenge facing the physician evaluating patients with transient ischemic attack is dete... more A major challenge facing the physician evaluating patients with transient ischemic attack is determining which patients are at highest short-term risk of stroke. A number of stratification schemes have been recently developed incorporating easily obtainable clinical information about the individual patient. Further, emerging data suggest a role for brain and vascular imaging in risk stratification. Many aspects of acute management of transient ischemic attack, such as which patients should be hospitalized and choice of acute antithrombotic therapy, remain controversial because of a lack of evidence from controlled trials. For longer-term prevention, there is much firmer evidence from multiple large randomized trials, and these data are reviewed in this article.

The American Journal of Cardiology, 2004

A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular... more A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular dysfunction.

The American Journal of Cardiology, 2008

Reversible cardiomyopathy has been reported in patients after liver transplantation. However, the... more Reversible cardiomyopathy has been reported in patients after liver transplantation. However, there are few data on the incidence, risk factors, and prognosis of this condition. Liver transplantation recipients who underwent preoperative right-and left-sided cardiac catheterization as well as preoperative transthoracic echocardiography from 2001 to 2005 were identified. Eighty-six patients met the outlined criteria and were included in the study. The incidence of severe heart failure (HF) after transplantation in this population was 6 of 86 (approximately 7%). Patients who developed HF were slightly older (mean age 61.2 ؎ 8.9 vs 55.4 ؎ 9.2 years, p ‫؍‬ 0.08) but had similar preoperative ejection fractions (60 ؎ 5% vs 57 ؎ 8%, p ‫؍‬ 0.22) and comparable systemic arterial blood pressure (116 ؎ 22/62 ؎ 11 vs 127 ؎ 9/66 ؎ 9, p >0.1). In addition, the severity of liver disease as measured by the model for end-stage liver disease score was not different between the 2 groups (23.9 ؎ 9.7 vs 26 ؎ 10.7, p ‫؍‬ 0.5). There was also no significant difference in the preoperative cardiac index (3.8 ؎ 1 vs 3.6 ؎ 1.5 L/min/m 2 , p ‫؍‬ 0.9) or pulmonary artery wedge pressure (13.6 ؎ 5.8 vs 15.3 ؎ 2.8 mm Hg, p ‫؍‬ 0.42). The incidence of alcohol use as the presumed cause of liver failure was equivalent in the 2 groups (33% vs 25%, p ‫؍‬ 0.65). The patients who developed HF did have significantly higher preoperative mean pulmonary arterial systolic pressures (43 ؎ 10 vs 30 ؎ 9 mm Hg, p ‫؍‬ 0.02) and right ventricular systolic pressures (44 ؎ 13 vs 34 ؎ 8 mm Hg, p ‫؍‬ 0.05). In conclusion, severe systolic HF may occur after liver transplantation in patients without traditional risk factors for HF. This study suggests that those patients with preoperative elevated right-sided cardiac pressures, as well as older patients, may be at excess risk for developing HF after transplantation.

Journal of the American College of Cardiology, 2010

Background: Hemodynamic assessment can be particularly challenging in overweight and obese patien... more Background: Hemodynamic assessment can be particularly challenging in overweight and obese patients with heart failure as the physical exam often limits the ability to assess filling pressures. This presents a need for a non-invasive test such as serum BNP to assist in hemodynamic evaluation. We compared the relationship between BNP levels and PCWP in lean, overweight, and obese patients. Methods: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial randomized patients hospitalized with decompensated heart failure to medical therapy guided by a pulmonary arterial catheter or to clinical assessment alone. Of 433 patients randomized, 109 had BMI, PCWP, and BNP data and were included in this analysis. Patients were categorized based on their BMI as lean (BMI<25), overweight (BMI 25-29.9), or obese (BMI ≥ 30). Results: Of 109 patients, 48 patients were lean, 29 overweight, and 32 obese. Mean PCWP among lean, overweight, and obese patients was 16.5, 19.55, and 21.03 mmHg respectively (p=0.017). Mean BNP among lean, overweight, and obese patients was 1046, 443, and 614 pg/ml respectively (p=0.002). As PCWP increased there was a significant blunting of BNP elevation among overweight and obese patients compared to their lean counterparts (p=0.012). Conclusions: Although BNP correlates with PCWP, there is a marked blunting of BNP in overweight and obese patients. BMI must be considered when interpreting BNP levels in patients with heart failure.

The American Journal of Cardiology, 2008

Reversible cardiomyopathy has been reported in patients after liver transplantation. However, the... more Reversible cardiomyopathy has been reported in patients after liver transplantation. However, there are few data on the incidence, risk factors, and prognosis of this condition. Liver transplantation recipients who underwent preoperative right-and left-sided cardiac catheterization as well as preoperative transthoracic echocardiography from 2001 to 2005 were identified. Eighty-six patients met the outlined criteria and were included in the study. The incidence of severe heart failure (HF) after transplantation in this population was 6 of 86 (approximately 7%). Patients who developed HF were slightly older (mean age 61.2 ؎ 8.9 vs 55.4 ؎ 9.2 years, p ‫؍‬ 0.08) but had similar preoperative ejection fractions (60 ؎ 5% vs 57 ؎ 8%, p ‫؍‬ 0.22) and comparable systemic arterial blood pressure (116 ؎ 22/62 ؎ 11 vs 127 ؎ 9/66 ؎ 9, p >0.1). In addition, the severity of liver disease as measured by the model for end-stage liver disease score was not different between the 2 groups (23.9 ؎ 9.7 vs 26 ؎ 10.7, p ‫؍‬ 0.5). There was also no significant difference in the preoperative cardiac index (3.8 ؎ 1 vs 3.6 ؎ 1.5 L/min/m 2 , p ‫؍‬ 0.9) or pulmonary artery wedge pressure (13.6 ؎ 5.8 vs 15.3 ؎ 2.8 mm Hg, p ‫؍‬ 0.42). The incidence of alcohol use as the presumed cause of liver failure was equivalent in the 2 groups (33% vs 25%, p ‫؍‬ 0.65). The patients who developed HF did have significantly higher preoperative mean pulmonary arterial systolic pressures (43 ؎ 10 vs 30 ؎ 9 mm Hg, p ‫؍‬ 0.02) and right ventricular systolic pressures (44 ؎ 13 vs 34 ؎ 8 mm Hg, p ‫؍‬ 0.05). In conclusion, severe systolic HF may occur after liver transplantation in patients without traditional risk factors for HF. This study suggests that those patients with preoperative elevated right-sided cardiac pressures, as well as older patients, may be at excess risk for developing HF after transplantation.

The Joint Commission Journal on Quality and Patient Safety, 2022

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Current Treatment Options in Cardiovascular Medicine, 2021

Purpose of Review The COVID-19 pandemic has had a profound impact on athletics, and the question ... more Purpose of Review The COVID-19 pandemic has had a profound impact on athletics, and the question of safely resuming competitive sports at all levels has been a source of significant debate. Concerns regarding myocarditis and the risk of arrhythmias and sudden death in athletes have prompted heightened attention to the role of cardiovascular screening. In this review, we aim to comprehensively outline the cardiovascular manifestations associated with COVID-19 infection, to discuss screening, diagnosis, and treatment strategies, and to evaluate the current literature on the risk to athletes and recommendations regarding return-to-play. Recent Findings COVID-19 is known to cause myocarditis, with presentations ranging from subclinical current or prior infection detected on cardiac MRI imaging, to fulminant heart failure and shock. While initial data early in the pandemic suggested that the risk of myocarditis could be significant even in patients with nonsevere COVID-19 infection, recent studies suggest a very low prevalence of clinically significant disease in young athletes. Summary While COVID-19 can have significant cardiovascular manifestations, recent data demonstrate that a screening approach guided by severity of COVID-19 infection and cardiovascular symptoms allows the majority of athletes to safely return to play in a timely manner. We must continue to tailor our approach to screening athletes as knowledge grows, and further research on the longitudinal cardiovascular effects of COVID-19 is needed.

JAMA Cardiology, 2021

; for the Big Ten COVID-19 Cardiac Registry Investigators IMPORTANCE Myocarditis is a leading cau... more ; for the Big Ten COVID-19 Cardiac Registry Investigators IMPORTANCE Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches. OBJECTIVE To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play.

Journal of the American College of Cardiology, 2016

Background: Pre-participation electrocardiographic (ECG) screening is a very sensitive approach t... more Background: Pre-participation electrocardiographic (ECG) screening is a very sensitive approach to detecting abnormalities conferring risk for sudden cardiac death. Because training alters the ECG, athlete-specific criteria such as the Seattle criteria have been developed to reduce the false discovery rate. Emerging data regarding Seattle criteria demonstrate a higher false discovery rate in black athletes than white athletes. Furthermore, gender differences in Seattle criteria performance are not well described. Objective: To characterize the positive predictive value of ECGs read by Seattle criteria for cardiovascular abnormalities in a large, multiethnic cross-section of athletes at an NCAA Division I program. Methods: In 2014 and 2015, 712 collegiate athletes (353 males, 359 females, average age 20) were evaluated by history, physical examination, 12-lead ECG, and further follow-up testing as needed. ECGs were analyzed according to Seattle Criteria. Positive rates by race and gender were determined; Fisher's exact test was used to compute significance. Results: Of 712 athletes screened, Seattle criteria were positive in 28 (3.9%). Positive ECGs were found in 12/109 (11.0%) black athletes and 16/562 (2.8%) white athletes (P < 0.001). In athletes of other races, 0/41 (0%) ECGs were positive. By race and gender, 11/255 (4.3%) white males, 5/307 (1.6%) white females, 6/86 (6.9%) black males, and 6/23 (26%) black females had positive findings. Compared to gender matched controls, black male athletes had a 2.4x (P < 0.05), and black female athletes had a 16.3x (P < 0.0001) relative risk of an abnormal ECG by Seattle criteria. Downstream testing disclosed bicuspid aortic valve in one white male athlete. Thus in this cohort, the positive predictive value of ECG screening by Seattle criteria was 1/28 (3.5%), for a false discovery rate of 96.4%. Conclusions: In this cohort, positive rates for ECGs were higher in black athletes compared to white athletes, and the overall positive predictive value of ECG screening by Seattle Criteria was low. High rates of ECG abnormalities were found in black female athletes. Subanalyses in other published cohorts can confirm if this finding is robust.

Current Atherosclerosis Reports, 2004

Management of Heart Failure

ABSTRACT This chapter outlines the practical, initial 24 h of management in patients with acute h... more ABSTRACT This chapter outlines the practical, initial 24 h of management in patients with acute heart failure syndromes (AHFS). In the United States, emergency department (ED) physicians and internists provide the majority of management.

Journal of the American College of Cardiology, 2003

B-Type Natriuretic Peptide Predicts Lefi Ventricular Response to Surgery in Patients With Severe ... more B-Type Natriuretic Peptide Predicts Lefi Ventricular Response to Surgery in Patients With Severe Mitral Regurgitation in Asymptomatic Patients With Preserved Left Ventricular Function Conlusions: NT-proBNP was closely linked to severity of aortic stenosis and therefor may be usefull for therapeutical decision making.

Journal of the American College of Cardiology, 2002

The Journal of the American Board of Family Medicine, 1998

The Journal of Pediatrics, 2011

Objective-A pilot study of adults who had onset of juvenile dermatomyositis (JDM) in childhood, b... more Objective-A pilot study of adults who had onset of juvenile dermatomyositis (JDM) in childhood, before current therapeutic approaches, to characterize JDM symptoms and subclinical cardiovascular disease. Study design-Eight adults who had JDM assessed for disease activity and 8 healthy adults (cardiovascular disease controls) were tested for carotid intima media thickness and brachial arterial reactivity. Adults who had JDM and 16 age-, sex-, and body mass index-matched healthy metabolic controls were evaluated for body composition, blood pressure, fasting glucose, lipids, insulin resistance, leptin, adiponectin, proinflammatory oxidized high-density lipoprotein (HDL), and nail-fold capillary end row loops. Results-Adults with a history of JDM, median age 38 years (24-44 years) enrolled a median 29 years (9-38 years) after disease onset, had elevated disease activity scores, skin (7/8), muscle (4/8), and creatine phosphokinase (2/8). Compared with cardiovascular disease controls, adults who had JDM were younger, had lower body mass index and HDL cholesterol (P = .002), and increased intima media thickness (P = .015) and their brachial arterial reactivity suggested impairment of endothelial cell function. Compared with metabolic controls, adults who had JDM had higher systolic and diastolic blood pressure, P = .

Journal of Nuclear Cardiology, 2007

Annals of Internal Medicine, 2011

A major challenge facing the physician evaluating patients with transient ischemic attack is dete... more A major challenge facing the physician evaluating patients with transient ischemic attack is determining which patients are at highest short-term risk of stroke. A number of stratification schemes have been recently developed incorporating easily obtainable clinical information about the individual patient. Further, emerging data suggest a role for brain and vascular imaging in risk stratification. Many aspects of acute management of transient ischemic attack, such as which patients should be hospitalized and choice of acute antithrombotic therapy, remain controversial because of a lack of evidence from controlled trials. For longer-term prevention, there is much firmer evidence from multiple large randomized trials, and these data are reviewed in this article.

The American Journal of Cardiology, 2004

A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular... more A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular dysfunction.

The American Journal of Cardiology, 2008

Reversible cardiomyopathy has been reported in patients after liver transplantation. However, the... more Reversible cardiomyopathy has been reported in patients after liver transplantation. However, there are few data on the incidence, risk factors, and prognosis of this condition. Liver transplantation recipients who underwent preoperative right-and left-sided cardiac catheterization as well as preoperative transthoracic echocardiography from 2001 to 2005 were identified. Eighty-six patients met the outlined criteria and were included in the study. The incidence of severe heart failure (HF) after transplantation in this population was 6 of 86 (approximately 7%). Patients who developed HF were slightly older (mean age 61.2 ؎ 8.9 vs 55.4 ؎ 9.2 years, p ‫؍‬ 0.08) but had similar preoperative ejection fractions (60 ؎ 5% vs 57 ؎ 8%, p ‫؍‬ 0.22) and comparable systemic arterial blood pressure (116 ؎ 22/62 ؎ 11 vs 127 ؎ 9/66 ؎ 9, p >0.1). In addition, the severity of liver disease as measured by the model for end-stage liver disease score was not different between the 2 groups (23.9 ؎ 9.7 vs 26 ؎ 10.7, p ‫؍‬ 0.5). There was also no significant difference in the preoperative cardiac index (3.8 ؎ 1 vs 3.6 ؎ 1.5 L/min/m 2 , p ‫؍‬ 0.9) or pulmonary artery wedge pressure (13.6 ؎ 5.8 vs 15.3 ؎ 2.8 mm Hg, p ‫؍‬ 0.42). The incidence of alcohol use as the presumed cause of liver failure was equivalent in the 2 groups (33% vs 25%, p ‫؍‬ 0.65). The patients who developed HF did have significantly higher preoperative mean pulmonary arterial systolic pressures (43 ؎ 10 vs 30 ؎ 9 mm Hg, p ‫؍‬ 0.02) and right ventricular systolic pressures (44 ؎ 13 vs 34 ؎ 8 mm Hg, p ‫؍‬ 0.05). In conclusion, severe systolic HF may occur after liver transplantation in patients without traditional risk factors for HF. This study suggests that those patients with preoperative elevated right-sided cardiac pressures, as well as older patients, may be at excess risk for developing HF after transplantation.

Journal of the American College of Cardiology, 2010

Background: Hemodynamic assessment can be particularly challenging in overweight and obese patien... more Background: Hemodynamic assessment can be particularly challenging in overweight and obese patients with heart failure as the physical exam often limits the ability to assess filling pressures. This presents a need for a non-invasive test such as serum BNP to assist in hemodynamic evaluation. We compared the relationship between BNP levels and PCWP in lean, overweight, and obese patients. Methods: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial randomized patients hospitalized with decompensated heart failure to medical therapy guided by a pulmonary arterial catheter or to clinical assessment alone. Of 433 patients randomized, 109 had BMI, PCWP, and BNP data and were included in this analysis. Patients were categorized based on their BMI as lean (BMI<25), overweight (BMI 25-29.9), or obese (BMI ≥ 30). Results: Of 109 patients, 48 patients were lean, 29 overweight, and 32 obese. Mean PCWP among lean, overweight, and obese patients was 16.5, 19.55, and 21.03 mmHg respectively (p=0.017). Mean BNP among lean, overweight, and obese patients was 1046, 443, and 614 pg/ml respectively (p=0.002). As PCWP increased there was a significant blunting of BNP elevation among overweight and obese patients compared to their lean counterparts (p=0.012). Conclusions: Although BNP correlates with PCWP, there is a marked blunting of BNP in overweight and obese patients. BMI must be considered when interpreting BNP levels in patients with heart failure.

The American Journal of Cardiology, 2008

Reversible cardiomyopathy has been reported in patients after liver transplantation. However, the... more Reversible cardiomyopathy has been reported in patients after liver transplantation. However, there are few data on the incidence, risk factors, and prognosis of this condition. Liver transplantation recipients who underwent preoperative right-and left-sided cardiac catheterization as well as preoperative transthoracic echocardiography from 2001 to 2005 were identified. Eighty-six patients met the outlined criteria and were included in the study. The incidence of severe heart failure (HF) after transplantation in this population was 6 of 86 (approximately 7%). Patients who developed HF were slightly older (mean age 61.2 ؎ 8.9 vs 55.4 ؎ 9.2 years, p ‫؍‬ 0.08) but had similar preoperative ejection fractions (60 ؎ 5% vs 57 ؎ 8%, p ‫؍‬ 0.22) and comparable systemic arterial blood pressure (116 ؎ 22/62 ؎ 11 vs 127 ؎ 9/66 ؎ 9, p >0.1). In addition, the severity of liver disease as measured by the model for end-stage liver disease score was not different between the 2 groups (23.9 ؎ 9.7 vs 26 ؎ 10.7, p ‫؍‬ 0.5). There was also no significant difference in the preoperative cardiac index (3.8 ؎ 1 vs 3.6 ؎ 1.5 L/min/m 2 , p ‫؍‬ 0.9) or pulmonary artery wedge pressure (13.6 ؎ 5.8 vs 15.3 ؎ 2.8 mm Hg, p ‫؍‬ 0.42). The incidence of alcohol use as the presumed cause of liver failure was equivalent in the 2 groups (33% vs 25%, p ‫؍‬ 0.65). The patients who developed HF did have significantly higher preoperative mean pulmonary arterial systolic pressures (43 ؎ 10 vs 30 ؎ 9 mm Hg, p ‫؍‬ 0.02) and right ventricular systolic pressures (44 ؎ 13 vs 34 ؎ 8 mm Hg, p ‫؍‬ 0.05). In conclusion, severe systolic HF may occur after liver transplantation in patients without traditional risk factors for HF. This study suggests that those patients with preoperative elevated right-sided cardiac pressures, as well as older patients, may be at excess risk for developing HF after transplantation.