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Papers by Ravin Davidoff
Journal of the American Society of Echocardiography, 1995
Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 382, May 1995, Auth... more Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 382, May 1995, Authors:Robert C Capodilupo; Ravin Davidoff; Robert J Hilkert; Gabriel S Aldea; Lisa A Mendes; Patrice A McKenney; Richard J Shemin; Gilbert P Connelly.
New England Journal of Medicine, 2001
The conventional treatment strategy for patients with atrial fibrillation who are to undergo elec... more The conventional treatment strategy for patients with atrial fibrillation who are to undergo electrical cardioversion is to prescribe warfarin for anticoagulation for three weeks before cardioversion. It has been proposed that if transesophageal echocardiography reveals no atrial thrombus, cardioversion may be performed safely after only a short period of anticoagulant therapy. In a multicenter, randomized, prospective clinical trial, we enrolled 1222 patients with atrial fibrillation of more than two days' duration and assigned them to either treatment guided by the findings on transesophageal echocardiography or conventional treatment. The composite primary end point was cerebrovascular accident, transient ischemic attack, and peripheral embolism within eight weeks. Secondary end points were functional status, successful restoration and maintenance of sinus rhythm, hemorrhage, and death. There was no significant difference between the two treatment groups in the rate of embolic events (five embolic events among 619 patients in the transesophageal-echocardiography group [0.8 percent]) vs. three among 603 patients in the conventional-treatment group [0.5 percent], P=0.50). However, the rate of hemorrhagic events was significantly lower in the transesophageal-echocardiography group (18 events [2.9 percent] vs. 33 events [5.5 percent], P=0.03). Patients in the transesophageal-echocardiography group also had a shorter time to cardioversion (mean [+/-SD], 3.0+/-5.6 vs. 30.6+/-10.6 days, P<0.001) and a greater rate of successful restoration of sinus rhythm (440 patients [71.1 percent] vs. 393 patients [65.2 percent], P=0.03). At eight weeks, there were no significant differences between the two groups in the rates of death or maintenance of sinus rhythm or in functional status. The use of transesophageal echocardiography to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned.
Journal of the American Society of Echocardiography, 2008
Journal of the American Society of Echocardiography, 2004
Objective: This study was performed to clarify whether the longitudinal myocardial velocity gradi... more Objective: This study was performed to clarify whether the longitudinal myocardial velocity gradient could give new insights into the features of congestive heart failure in patients with primary amyloidosis. Methods: A total of 33 consecutive patients with biopsy specimen-proven primary amyloidosis were examined by pulsed Doppler tissue imaging. Results: In all, 22 had evidence of heart involvement, of whom 11 had clinical congestive heart failure. Sample volumes were placed on basal and midventricle in the apical 2-and 4-chamber views. Peak systolic, and peak early and late diastolic wallmotion velocities were measured at each site. Longitudinal myocardial velocity gradients were calcu-lated as the difference between basal and midmyocardial velocities. Single-point analysis of pulsed Doppler tissue imaging could not distinguish any difference among groups, whereas the longitudinal myocardial velocity gradients in systole and early diastole were significantly impaired in the patients with congestive heart failure compared with both the patients without cardiac involvement and those with cardiac amyloidosis without congestive heart failure.
Journal of the American College of Cardiology, 1989
The effect of infarct maturation on the temporal sequence of contraction within infarct zones has... more The effect of infarct maturation on the temporal sequence of contraction within infarct zones has not previously been described. Accordingly, the time-varying pattern of contraction within ischemic/infarct zones was studied with use of cross-sectional echocardiography in 17 dogs at 10 min to 6 weeks after acute experimental myocardial infarction.
Journal of the American College of Cardiology, 1995
Journal of the American College of Cardiology, 1995
Gr III (n = 14) 11 (78%) 3(22%) 5(71%) 2(29%) Gr II (n~7) Gr I In~9) 2(22%) 7(78%) Prevalence of ... more Gr III (n = 14) 11 (78%) 3(22%) 5(71%) 2(29%) Gr II (n~7) Gr I In~9) 2(22%) 7(78%) Prevalence of Fibrin Strands at Transesophageal Echocardiography Benjamin F. Byrd, III. James T. White, Vanderbilt University. Nashville, TN Chi square = 7.74, P < 0.05 MVT no MVT
Journal of the American College of Cardiology, 2004
Journal of the American College of Cardiology, 1998
JACC Fchrunn, 1~8 no|lemorgoncy pmc~}dures (15% valves, 63% CABG) wore pedormod at 3 hospitals, A... more JACC Fchrunn, 1~8 no|lemorgoncy pmc~}dures (15% valves, 63% CABG) wore pedormod at 3 hospitals, A multt.fecetod system employed allopurlnol, strict but simple myooardlat protection, steroids, high porfuslon pressure bypass, attention to aortic plaque, fluid restriction, surgical flexibility, and efficiency In poatoporalive management, A unique technique of msmmary artery preparation and testing maximized cardiac reparfuelon In CABG, Median LOS was 5 days, with 37% discharged in ~:4 days, 18% in ~3 days, while 4,8% wore discharged In ~2 days, In octogenarians, thn rledlan LOS was 5 days, with 25% dlechargad in <_3 day =,, Similarly, discharges occurred in ~4 days in 38% of pie with EF ~35%, Only 14% had atrial lil~rlllatlen, which was treated with oral agents to expedite ambulation, Infection fate w~s 2,4%, Strekes occurred In 1,4% and porloporetivo Infamflon in 0,9%, Intubatlon bayend 24 hours was needed in only 3,3%, No Inofmpto support was required in 40%, only 2,9% needed IABP, and 74% of pts were complication tree, Applleallon of this enhanced r~overy protocol minimizes perloporatlve cardtopulmonary and cerebral dysfunction, The banaflts appear to be inde. pandant of ago, pro.operative emdiopulmonary status, and surgical in~fifu. tten,
Journal of the American College of Cardiology, 1991
To enhance the echocardiographic identification of high risk lesions in patients with infectious ... more To enhance the echocardiographic identification of high risk lesions in patients with infectious endocarditis, the medical records and two-dimensional echocardiograms of 204 patients with this condition were analyzed. The occurrence of specific clinical complications was recorded and vegetations were assessed with respect to predetermined morphologic characteristics. The overall complication rates were roughly equivalent for patients with mitral (53%), aortic (62%), tricuspid (77%) and prosthetic valve (61%) vegetations, as well as for those with nonspecific valvular changes but no discrete vegetations (57%), although the distribution of specific complications varied considerably among these groups. There were significantly fewer complications in patients without discernible valvular abnormalities (27%). In native left-sided valve endocarditis, vegetation size, extent, mobility and consistency were all found to be significant univariate predictors of complications. In multivariate analysis, vegetation size, extent and mobility emerged as optimal predictors and an echocardiographic score based on these factors predicted the occurrence of complications with 70% sensitivity and 92% specificity in mitral valve endocarditis and with 76% sensitivity and 62% specificity in aortic valve endocarditis.
Journal of the American College of Cardiology, 1995
Objectives. This study attempted to determine the importance of severe proximal right coronary ar... more Objectives. This study attempted to determine the importance of severe proximal right coronary artery disease as a predictor of atrial fibrillation in patients after coronary artery bypass surgery.
Journal of the American College of Cardiology, 2003
The purpose of this study was to determine the characteristics and outcomes of patients with acut... more The purpose of this study was to determine the characteristics and outcomes of patients with acute myocardial infarction (MI) complicated by cardiogenic shock due to predominant right ventricular (RV) infarction. BACKGROUND Although RV infarction has been shown to have favorable long-term outcomes, the influence of RV infarction on mortality in cardiogenic shock is unknown.
Journal of the American College of Cardiology, 1996
Journal of the American College of Cardiology, 1996
Journal of the American College of Cardiology, 2004
Journal of the American College of Cardiology, 2002
side evaluation as potential predictors of death in the 7,796 subjects enrolled in the GUSTO IV t... more side evaluation as potential predictors of death in the 7,796 subjects enrolled in the GUSTO IV tdal with 301 deaths at 30 days (3.86%). Univariate logistic regression models were fit to the data and then multivariate logistic regression models were developed and creating a simplified scoring system using the Hosmer-Lemeshow goodness of fit statistics and c-index. The predictive accuracy of the multivadable model was assessed using bootstrap methods. Results: The final multivariate model included age (2 points plus additional 2 points for every decade above 50), 4 major criteria (history of heart failure, stroke/transient ischemic attacks, renal insufficiency or elevated CK-MB -each 2 points) and 6 minor predictors (elevated troponin and C-reactive protein, ST depression, anemia, hypercholesterolemia and history of coronary disease -each 1 point). Thirty-day mortality increased significantly with a dsing score (0.29% for 0-4 points, 1.75 % for 5-9 points; 7.17% for 11-14 points, 24% for >15 points). This model provides a robust risk scoring system with a cindex of 0.797 (range from 0.744 to 0.841 using bootstrap methods, compared to 0.56 in the TIMI risk score for 14-day mortality). In the final multivariate model, traditional risk factors such as male gender, diabetes mellitus, hypertension, prior aspidn use, recent angina and current smoking history has little effect on the model performance in predicting 30-day mortality. Conclusion: The GUSTO risk score provides a simple and easy-to-use risk scoring system that incorporates multiple factors in predicting 30-day risk of death in patients presenting with ACS. This risk score illustrates the importance of age and comorbid conditions in the process of risk stratification.
Journal of Neuroimaging, 2002
Background and Purpose. A potential source of emboli is not detected in more than 50% of patients... more Background and Purpose. A potential source of emboli is not detected in more than 50% of patients with retinal arterial occlusive events. Echocardiographic studies are not always included in the diagnostic workup of these patients. The authors studied the diagnostic yield of transthoracic (TTE) and/or transesophageal (TEE) echocardiography in identifying potential sources of emboli in patients with retinal ischemia or embolism. Methods. In a prospective study, 73 consecutive patients with clinically diagnosed retinal ischemia or embolism received a standardized diagnostic workup including retinal photography, echocardiography, and imaging studies of the internal carotid arteries. TTE was performed in 83.6% of patients, TEE was performed in 5.5% of patients, and both TTE and TEE were performed in 11.0% of patients. Ophthalmological diagnoses consisted of amaurosis fugax (n = 28), asymptomatic cholesterol embolism to the retina (n = 34), and branch or central retinal artery occlusion (n = 11). Results. Echocardiography identified a potential cardiac or proximal aortic source for embolism in 16 of 73 (21.9%) patients, including 8 who also had either atrial fibrillation or internal carotid artery stenosis of more than 50% on the side of interest. Thus, 8 of 73 (11.0%) patients had lesions detected only by echocardiography. The most commonly identified lesions were proximal aortic plaque of more than 4 mm thickness (n = 7, 9.6%) and left ventricular ejection fraction of less than 30% (n = 6, 8.2%). TEE was particularly helpful in identifying prominent aortic plaques. Conclusion. Echocardiography frequently identifies lesions of the heart or aortic arch that can act as potential sources for retinal ischemia or embolism. Further studies are needed to evaluate the prognostic and therapeutic relevance of these findings.
Journal of the American Society of Echocardiography, 1995
Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 382, May 1995, Auth... more Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 382, May 1995, Authors:Robert C Capodilupo; Ravin Davidoff; Robert J Hilkert; Gabriel S Aldea; Lisa A Mendes; Patrice A McKenney; Richard J Shemin; Gilbert P Connelly.
New England Journal of Medicine, 2001
The conventional treatment strategy for patients with atrial fibrillation who are to undergo elec... more The conventional treatment strategy for patients with atrial fibrillation who are to undergo electrical cardioversion is to prescribe warfarin for anticoagulation for three weeks before cardioversion. It has been proposed that if transesophageal echocardiography reveals no atrial thrombus, cardioversion may be performed safely after only a short period of anticoagulant therapy. In a multicenter, randomized, prospective clinical trial, we enrolled 1222 patients with atrial fibrillation of more than two days' duration and assigned them to either treatment guided by the findings on transesophageal echocardiography or conventional treatment. The composite primary end point was cerebrovascular accident, transient ischemic attack, and peripheral embolism within eight weeks. Secondary end points were functional status, successful restoration and maintenance of sinus rhythm, hemorrhage, and death. There was no significant difference between the two treatment groups in the rate of embolic events (five embolic events among 619 patients in the transesophageal-echocardiography group [0.8 percent]) vs. three among 603 patients in the conventional-treatment group [0.5 percent], P=0.50). However, the rate of hemorrhagic events was significantly lower in the transesophageal-echocardiography group (18 events [2.9 percent] vs. 33 events [5.5 percent], P=0.03). Patients in the transesophageal-echocardiography group also had a shorter time to cardioversion (mean [+/-SD], 3.0+/-5.6 vs. 30.6+/-10.6 days, P<0.001) and a greater rate of successful restoration of sinus rhythm (440 patients [71.1 percent] vs. 393 patients [65.2 percent], P=0.03). At eight weeks, there were no significant differences between the two groups in the rates of death or maintenance of sinus rhythm or in functional status. The use of transesophageal echocardiography to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned.
Journal of the American Society of Echocardiography, 2008
Journal of the American Society of Echocardiography, 2004
Objective: This study was performed to clarify whether the longitudinal myocardial velocity gradi... more Objective: This study was performed to clarify whether the longitudinal myocardial velocity gradient could give new insights into the features of congestive heart failure in patients with primary amyloidosis. Methods: A total of 33 consecutive patients with biopsy specimen-proven primary amyloidosis were examined by pulsed Doppler tissue imaging. Results: In all, 22 had evidence of heart involvement, of whom 11 had clinical congestive heart failure. Sample volumes were placed on basal and midventricle in the apical 2-and 4-chamber views. Peak systolic, and peak early and late diastolic wallmotion velocities were measured at each site. Longitudinal myocardial velocity gradients were calcu-lated as the difference between basal and midmyocardial velocities. Single-point analysis of pulsed Doppler tissue imaging could not distinguish any difference among groups, whereas the longitudinal myocardial velocity gradients in systole and early diastole were significantly impaired in the patients with congestive heart failure compared with both the patients without cardiac involvement and those with cardiac amyloidosis without congestive heart failure.
Journal of the American College of Cardiology, 1989
The effect of infarct maturation on the temporal sequence of contraction within infarct zones has... more The effect of infarct maturation on the temporal sequence of contraction within infarct zones has not previously been described. Accordingly, the time-varying pattern of contraction within ischemic/infarct zones was studied with use of cross-sectional echocardiography in 17 dogs at 10 min to 6 weeks after acute experimental myocardial infarction.
Journal of the American College of Cardiology, 1995
Journal of the American College of Cardiology, 1995
Gr III (n = 14) 11 (78%) 3(22%) 5(71%) 2(29%) Gr II (n~7) Gr I In~9) 2(22%) 7(78%) Prevalence of ... more Gr III (n = 14) 11 (78%) 3(22%) 5(71%) 2(29%) Gr II (n~7) Gr I In~9) 2(22%) 7(78%) Prevalence of Fibrin Strands at Transesophageal Echocardiography Benjamin F. Byrd, III. James T. White, Vanderbilt University. Nashville, TN Chi square = 7.74, P < 0.05 MVT no MVT
Journal of the American College of Cardiology, 2004
Journal of the American College of Cardiology, 1998
JACC Fchrunn, 1~8 no|lemorgoncy pmc~}dures (15% valves, 63% CABG) wore pedormod at 3 hospitals, A... more JACC Fchrunn, 1~8 no|lemorgoncy pmc~}dures (15% valves, 63% CABG) wore pedormod at 3 hospitals, A multt.fecetod system employed allopurlnol, strict but simple myooardlat protection, steroids, high porfuslon pressure bypass, attention to aortic plaque, fluid restriction, surgical flexibility, and efficiency In poatoporalive management, A unique technique of msmmary artery preparation and testing maximized cardiac reparfuelon In CABG, Median LOS was 5 days, with 37% discharged in ~:4 days, 18% in ~3 days, while 4,8% wore discharged In ~2 days, In octogenarians, thn rledlan LOS was 5 days, with 25% dlechargad in <_3 day =,, Similarly, discharges occurred in ~4 days in 38% of pie with EF ~35%, Only 14% had atrial lil~rlllatlen, which was treated with oral agents to expedite ambulation, Infection fate w~s 2,4%, Strekes occurred In 1,4% and porloporetivo Infamflon in 0,9%, Intubatlon bayend 24 hours was needed in only 3,3%, No Inofmpto support was required in 40%, only 2,9% needed IABP, and 74% of pts were complication tree, Applleallon of this enhanced r~overy protocol minimizes perloporatlve cardtopulmonary and cerebral dysfunction, The banaflts appear to be inde. pandant of ago, pro.operative emdiopulmonary status, and surgical in~fifu. tten,
Journal of the American College of Cardiology, 1991
To enhance the echocardiographic identification of high risk lesions in patients with infectious ... more To enhance the echocardiographic identification of high risk lesions in patients with infectious endocarditis, the medical records and two-dimensional echocardiograms of 204 patients with this condition were analyzed. The occurrence of specific clinical complications was recorded and vegetations were assessed with respect to predetermined morphologic characteristics. The overall complication rates were roughly equivalent for patients with mitral (53%), aortic (62%), tricuspid (77%) and prosthetic valve (61%) vegetations, as well as for those with nonspecific valvular changes but no discrete vegetations (57%), although the distribution of specific complications varied considerably among these groups. There were significantly fewer complications in patients without discernible valvular abnormalities (27%). In native left-sided valve endocarditis, vegetation size, extent, mobility and consistency were all found to be significant univariate predictors of complications. In multivariate analysis, vegetation size, extent and mobility emerged as optimal predictors and an echocardiographic score based on these factors predicted the occurrence of complications with 70% sensitivity and 92% specificity in mitral valve endocarditis and with 76% sensitivity and 62% specificity in aortic valve endocarditis.
Journal of the American College of Cardiology, 1995
Objectives. This study attempted to determine the importance of severe proximal right coronary ar... more Objectives. This study attempted to determine the importance of severe proximal right coronary artery disease as a predictor of atrial fibrillation in patients after coronary artery bypass surgery.
Journal of the American College of Cardiology, 2003
The purpose of this study was to determine the characteristics and outcomes of patients with acut... more The purpose of this study was to determine the characteristics and outcomes of patients with acute myocardial infarction (MI) complicated by cardiogenic shock due to predominant right ventricular (RV) infarction. BACKGROUND Although RV infarction has been shown to have favorable long-term outcomes, the influence of RV infarction on mortality in cardiogenic shock is unknown.
Journal of the American College of Cardiology, 1996
Journal of the American College of Cardiology, 1996
Journal of the American College of Cardiology, 2004
Journal of the American College of Cardiology, 2002
side evaluation as potential predictors of death in the 7,796 subjects enrolled in the GUSTO IV t... more side evaluation as potential predictors of death in the 7,796 subjects enrolled in the GUSTO IV tdal with 301 deaths at 30 days (3.86%). Univariate logistic regression models were fit to the data and then multivariate logistic regression models were developed and creating a simplified scoring system using the Hosmer-Lemeshow goodness of fit statistics and c-index. The predictive accuracy of the multivadable model was assessed using bootstrap methods. Results: The final multivariate model included age (2 points plus additional 2 points for every decade above 50), 4 major criteria (history of heart failure, stroke/transient ischemic attacks, renal insufficiency or elevated CK-MB -each 2 points) and 6 minor predictors (elevated troponin and C-reactive protein, ST depression, anemia, hypercholesterolemia and history of coronary disease -each 1 point). Thirty-day mortality increased significantly with a dsing score (0.29% for 0-4 points, 1.75 % for 5-9 points; 7.17% for 11-14 points, 24% for >15 points). This model provides a robust risk scoring system with a cindex of 0.797 (range from 0.744 to 0.841 using bootstrap methods, compared to 0.56 in the TIMI risk score for 14-day mortality). In the final multivariate model, traditional risk factors such as male gender, diabetes mellitus, hypertension, prior aspidn use, recent angina and current smoking history has little effect on the model performance in predicting 30-day mortality. Conclusion: The GUSTO risk score provides a simple and easy-to-use risk scoring system that incorporates multiple factors in predicting 30-day risk of death in patients presenting with ACS. This risk score illustrates the importance of age and comorbid conditions in the process of risk stratification.
Journal of Neuroimaging, 2002
Background and Purpose. A potential source of emboli is not detected in more than 50% of patients... more Background and Purpose. A potential source of emboli is not detected in more than 50% of patients with retinal arterial occlusive events. Echocardiographic studies are not always included in the diagnostic workup of these patients. The authors studied the diagnostic yield of transthoracic (TTE) and/or transesophageal (TEE) echocardiography in identifying potential sources of emboli in patients with retinal ischemia or embolism. Methods. In a prospective study, 73 consecutive patients with clinically diagnosed retinal ischemia or embolism received a standardized diagnostic workup including retinal photography, echocardiography, and imaging studies of the internal carotid arteries. TTE was performed in 83.6% of patients, TEE was performed in 5.5% of patients, and both TTE and TEE were performed in 11.0% of patients. Ophthalmological diagnoses consisted of amaurosis fugax (n = 28), asymptomatic cholesterol embolism to the retina (n = 34), and branch or central retinal artery occlusion (n = 11). Results. Echocardiography identified a potential cardiac or proximal aortic source for embolism in 16 of 73 (21.9%) patients, including 8 who also had either atrial fibrillation or internal carotid artery stenosis of more than 50% on the side of interest. Thus, 8 of 73 (11.0%) patients had lesions detected only by echocardiography. The most commonly identified lesions were proximal aortic plaque of more than 4 mm thickness (n = 7, 9.6%) and left ventricular ejection fraction of less than 30% (n = 6, 8.2%). TEE was particularly helpful in identifying prominent aortic plaques. Conclusion. Echocardiography frequently identifies lesions of the heart or aortic arch that can act as potential sources for retinal ischemia or embolism. Further studies are needed to evaluate the prognostic and therapeutic relevance of these findings.