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Article: Peripartum Cardiomyopathy: Risks Diagnosis and Management.

Carlson, Selma / Schultz, Jessica / Ramu, Bhavadharini / Davis, Melinda B

2023 Volume 16, Page(s) 1249–1258

Abstract: Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered ...

Abstract	Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.
Language	English
Publishing date	2023-05-03
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2453343-9
ISSN	1178-2390
ISSN	1178-2390
DOI	10.2147/JMDH.S372747
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Article ; Online: Trajectory of left ventricular ejection fraction among individuals eligible for implantable cardioverter-defibrillator.

Carlson, Selma / Gravely, Amy / Adabag, Selçuk

Pacing and clinical electrophysiology : PACE

2021 Volume 44, Issue 5, Page(s) 800–806

Abstract: Objective: Examine the trajectory of left ventricular ejection fraction (EF) among patients eligible for implantable cardioverter-defibrillator (ICD) therapy.: Background: EF is the cornerstone criterion for ICD therapy, but the risk of sudden ... ...

Abstract	Objective: Examine the trajectory of left ventricular ejection fraction (EF) among patients eligible for implantable cardioverter-defibrillator (ICD) therapy. Background: EF is the cornerstone criterion for ICD therapy, but the risk of sudden cardiac death remains after an improvement in EF. Methods: We examined the trajectory of EF among 1178 participants of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) who had three or more assessments of EF, at least 90 days apart. A follow-up EF > 35% or >10% absolute increase in EF from baseline were examined as the criteria for EF improvement. Results: At first follow-up, 381 (32%) patients had an improvement of EF to >35%. However, EF had returned back to ≤35% in 109 (27%) of these patients at second follow-up. Similarly, 446 (38%) patients experienced a >10% improvement in EF at first follow-up, but 109 (24%) of these had a subsequent >10% decrease in EF at the second follow-up. Of the 32 patients with normalized EF (≥55%) at first follow-up, 18 (56%) had a subsequent >10% decrease in EF. The fluctuation in EF was present in both ischemic and nonischemic cardiomyopathy but a higher proportion of patients with nonischemic cardiomyopathy had an improvement in EF to >35% at first follow-up compared to those with ischemic cardiomyopathy (38% vs. 27%, p = < .0001). Conclusion: There is substantial fluctuation of EF among patients who are eligible for ICD therapy.
MeSH term(s)	Cardiomyopathies/physiopathology ; Cardiomyopathies/therapy ; Databases, Factual ; Death, Sudden, Cardiac/prevention & control ; Defibrillators, Implantable ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Stroke Volume ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Dysfunction, Left/therapy
Language	English
Publishing date	2021-03-31
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	424437-0
ISSN	1540-8159 ; 0147-8389
ISSN (online)	1540-8159
ISSN	0147-8389
DOI	10.1111/pace.14168
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Article ; Online: Multimodality imaging for prosthetic valves evaluation: Current understanding and future directions.

Carlson, Selma / Habib, Gilbert / Chen, Tiffany / Leipsic, Jonathon / Enriquez-Sarano, Maurice / Cavalcante, João L

Progress in cardiovascular diseases

2022 Volume 72, Page(s) 66–77

Abstract: The number of patients requiring heart valve surgery continues to increase with the growing life expectancy and expansion of both surgical and transcatheter valves. In patients with prosthetic heart valves (PHV), transthoracic echocardiography is the ... ...

Abstract	The number of patients requiring heart valve surgery continues to increase with the growing life expectancy and expansion of both surgical and transcatheter valves. In patients with prosthetic heart valves (PHV), transthoracic echocardiography is the mainstay for initial assessment and serial surveillance. However, multimodality imaging, including three-dimensional transesophageal echocardiography, cardiac computed tomography, cardiac magnetic resonance, fluoroscopy, and nuclear imaging, is becoming more commonly used clinically to aid in diagnosis and to identify the mechanism of PHV dysfunction. This review aims to provide an updated overview of the use of multimodality imaging in evaluation of PHVs, to illustrate the imaging appearance of different complications, and to highlight a practical approach to help clinical decision making in challenging cases of PHV dysfunction.
MeSH term(s)	Echocardiography/methods ; Echocardiography, Transesophageal ; Heart Valve Prosthesis ; Humans ; Multimodal Imaging/methods ; Prosthesis Failure
Language	English
Publishing date	2022-02-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	209312-1
ISSN	1873-1740 ; 1532-8643 ; 0033-0620
ISSN (online)	1873-1740 ; 1532-8643
ISSN	0033-0620
DOI	10.1016/j.pcad.2022.02.002
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Article ; Online: "Unstable angina" in a man aged 53 years.

Vincent, Logan L / Carlson, Selma D / Krieger, Eric V

Heart (British Cardiac Society)

2019 Volume 105, Issue 18, Page(s) 1431–1446

MeSH term(s)	Angina, Unstable/diagnosis ; Angina, Unstable/etiology ; Angina, Unstable/physiopathology ; Bortezomib/adverse effects ; Humans ; Male ; Middle Aged ; Multiple Myeloma/drug therapy ; Myocarditis/chemically induced ; Myocarditis/diagnostic imaging ; Myocarditis/drug therapy ; Myocarditis/physiopathology ; Proteasome Inhibitors/adverse effects ; Risk Factors ; Steroids/therapeutic use ; gamma-Globulins/therapeutic use
Chemical Substances	Proteasome Inhibitors ; Steroids ; gamma-Globulins ; Bortezomib (69G8BD63PP)
Language	English
Publishing date	2019-06-01
Publishing country	England
Document type	Case Reports
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2018-314651
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Article ; Online: Improvement of left ventricular function with surgical revascularization in patients eligible for implantable cardioverter-defibrillator.

Adabag, Selçuk / Carlson, Selma / Gravely, Amy / Buelt-Gebhardt, Melissa / Madjid, Mohammad / Naksuk, Niyada

Journal of cardiovascular electrophysiology

2021 Volume 33, Issue 2, Page(s) 244–251

Abstract: Introduction: Left ventricular ejection fraction (EF) ≤ 35% is the cornerstone criterion for implantable cardioverter-defibrillator (ICD) eligibility. Improvement in EF may occur in ICD-eligible patients after coronary artery bypass graft surgery (CABG). ...

Abstract	Introduction: Left ventricular ejection fraction (EF) ≤ 35% is the cornerstone criterion for implantable cardioverter-defibrillator (ICD) eligibility. Improvement in EF may occur in ICD-eligible patients after coronary artery bypass graft surgery (CABG). However, the incidence, predictors, and outcomes of this process are unclear. Methods and results: We studied 427 patients with EF ≤ 35% who underwent CABG in the Surgical Treatment for Ischemic Heart Failure (STICH) trial and had a systematic pre- and postoperative (4 months) EF assessment using the identical cardiac imaging modality. All imaging studies were interpreted at a core laboratory. Improvement in EF was defined as postoperative EF > 35% and >5% absolute improvement from baseline. Of the 427 patients (mean age 61.8 ± 9.5 and 50 women), 125 (29.2%) had EF improvement. Their mean EF increased from 26.8% (±5.8%) to 43.3% (±6.5%) (p < .0001). EF improvement occurred in only 20% of patients with a preoperative EF < 25%. The odds of EF improvement were 1.96 times higher (95% confidence interval [CI]: 0.91-4.23, p = .09) in patients with myocardial viability. In adjusted analyses, EF improvement was associated with a significantly lower risk of all-cause mortality (hazard ratio [HR]: 0.58, 95% CI: 0.35-0.96; p = .03) and heart failure mortality (HR: 0.31, 95% CI: 0.11-0.87; p = .027). Conclusion: Nearly 1/3rd of ICD-eligible patients undergoing CABG had significant improvement in EF, obviating the need for primary prevention ICD implantation. These results provide patients and clinicians data on the likelihood of ICD eligibility after CABG and support the practice of reassessment of EF after revascularization.
MeSH term(s)	Aged ; Coronary Artery Bypass ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Defibrillators, Implantable ; Female ; Humans ; Middle Aged ; Stroke Volume ; Treatment Outcome ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/therapy ; Ventricular Function, Left
Language	English
Publishing date	2021-12-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.15315
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Article ; Online: Perioperative changes in left ventricular systolic function following surgical revascularization.

Downey, Michael C / Hooks, Matthew / Gravely, Amy / Naksuk, Niyada / Buelt-Gebhardt, Melissa / Carlson, Selma / Tholakanahalli, Venkat / Adabag, Selçuk

PloS one

2022 Volume 17, Issue 11, Page(s) e0277454

Abstract: Background: Nearly 1/3rd of patients undergoing coronary artery bypass graft surgery (CABG) have left ventricular systolic dysfunction. However, the extent, direction and implications of perioperative changes in left ventricular ejection fraction (LVEF) ...

Abstract	Background: Nearly 1/3rd of patients undergoing coronary artery bypass graft surgery (CABG) have left ventricular systolic dysfunction. However, the extent, direction and implications of perioperative changes in left ventricular ejection fraction (LVEF) have not been well characterized in these patients. Methods: We studied the changes in LVEF among 549 patients with left ventricular systolic dysfunction (LVEF <50%) who underwent CABG as part of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Patients had pre- and post-CABG (4 month) LVEF assessments using identical cardiac imaging modality, interpreted at a core laboratory. An absolute change of >10% in LVEF was considered clinically significant. Results: Of the 549 patients (mean age 61.4±9.55 years, and 72 [13.1%] women), 145 (26.4%) had a >10% improvement in LVEF, 369 (67.2%) had no change and 35 (6.4%) had >10% worsening of LVEF following CABG. Patients with lower preoperative LVEF were more likely to experience an improvement after CABG (odds ratio 1.36; 95% CI 1.21-1.53; per 5% lower preoperative LVEF; p <0.001). Notably, incidence of postoperative improvement in LVEF was not influenced by presence, nor absence, of myocardial viability (25.5% vs. 28.3% respectively, p = 0.67). After adjusting for age, sex, baseline LVEF, and NYHA Class, a >10% improvement in LVEF after CABG was associated with a 57% lower risk of all-cause mortality (HR: 0.43, 95% CI: 0.26-0.71). Conclusions: Among patients with ischemic cardiomyopathy undergoing CABG, 26.4% had >10% improvement in LVEF. An improvement in LVEF was more likely in patients with lower preoperative LVEF and was associated with improved long-term survival.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Middle Aged ; Coronary Artery Bypass/adverse effects ; Coronary Artery Bypass/methods ; Myocardial Ischemia/complications ; Stroke Volume ; Treatment Outcome ; Ventricular Dysfunction, Left/etiology ; Ventricular Function, Left ; Clinical Trials as Topic
Language	English
Publishing date	2022-11-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0277454
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Article ; Online: Exertional dyspnoea in a 28-year-old woman.

Carlson, Selma D / Steinberg, Zachary L / Krieger, Eric V

Heart (British Cardiac Society)

2017 Volume 103, Issue 22, Page(s) 1779–1829

Abstract: Clinical introduction: A 28-year-old woman with a history of critical pulmonic stenosis, status postsurgical valvotomy and subsequent pulmonary valve replacement, presented to the cardiology clinic with 1 year of progressive exertional dyspnoea. She has ...

Abstract	Clinical introduction: A 28-year-old woman with a history of critical pulmonic stenosis, status postsurgical valvotomy and subsequent pulmonary valve replacement, presented to the cardiology clinic with 1 year of progressive exertional dyspnoea. She has a heart rate of 75 bpm and blood pressure of 110/55 mm Hg. Cardiac auscultation reveals a 1/6 systolic ejection murmur along the left sternum and an early 3/6 diastolic decrescendo murmur. A transthoracic echocardiogram is obtained (figure 1). Questions: Which of the following would be most likely found during right heart catheterisation?Ratio of pulmonary to systemic blood flow (Qp:Qs) >1.5Pulmonary vascular resistance >3 Wood unitsRight atrial pressure >10mm HgPulmonary artery systolic pressure >45mm Hg E. Pulmonary artery diastolic pressure <10mm Hg.
MeSH term(s)	Adult ; Atrial Function, Right ; Atrial Pressure ; Blood Pressure ; Cardiac Catheterization ; Dyspnea/etiology ; Echocardiography, Doppler, Pulsed ; Female ; Heart Rate ; Heart Valve Prosthesis Implantation/adverse effects ; Humans ; Physical Exertion ; Predictive Value of Tests ; Pulmonary Valve/physiopathology ; Pulmonary Valve/surgery ; Pulmonary Valve Insufficiency/diagnosis ; Pulmonary Valve Insufficiency/etiology ; Pulmonary Valve Insufficiency/physiopathology ; Pulmonary Valve Stenosis/diagnosis ; Pulmonary Valve Stenosis/physiopathology ; Pulmonary Valve Stenosis/surgery
Language	English
Publishing date	2017-11
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2017-312174
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Article ; Online: Performance of Comprehensive Transesophageal Echocardiography: Quality Improvement Through Educational Intervention.

Chen, Tiffany / Carlson, Selma / Cheney, Amy / Zwink, Todd / Freeman, Rosario V / Kirkpatrick, James N

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2019 Volume 32, Issue 8, Page(s) 1046–1048

MeSH term(s)	Cardiology/education ; Echocardiography, Transesophageal/standards ; Educational Measurement ; Female ; Humans ; Inservice Training ; Male ; Middle Aged ; Prospective Studies ; Quality Improvement ; Retrospective Studies
Language	English
Publishing date	2019-05-23
Publishing country	United States
Document type	Letter
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/j.echo.2019.03.019
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Article ; Online: Risk Prediction and Right Ventricular Dilation in a Single-Institution Pulmonary Arterial Hypertension Cohort.

Pi, Hongyang / Carlson, Selma D / Barros, Lia M / Hogl, Laurie / Kirkpatrick, James N / Nolley, Stephanie / Ralph, David D / Rayner, Samuel G / Leary, Peter J

Journal of the American Heart Association

2022 Volume 11, Issue 14, Page(s) e025521

MeSH term(s)	Cohort Studies ; Dilatation ; Familial Primary Pulmonary Hypertension ; Heart Ventricles ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/therapy ; Pulmonary Arterial Hypertension/diagnosis ; Pulmonary Artery/diagnostic imaging ; Ventricular Dysfunction, Right/diagnostic imaging ; Ventricular Dysfunction, Right/etiology ; Ventricular Function, Right
Language	English
Publishing date	2022-07-13
Publishing country	England
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.122.025521
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Article ; Online: Preliminary Interpretations of Transthoracic Echocardiograms by Cardiology Fellows.

Carlson, Selma / Kearney, Kathleen / Li, Song / Fujioka, Michelle / Schwaegler, Becky / Kirkpatrick, James N

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2017 Volume 30, Issue 12, Page(s) 1234–1238

Abstract: Background: Echocardiograms are often obtained after business hours on an urgent or emergent basis to assist in the care of patients with complex presentations. Considerable variation exists among academic medical centers with regard to who performs and ...

Abstract	Background: Echocardiograms are often obtained after business hours on an urgent or emergent basis to assist in the care of patients with complex presentations. Considerable variation exists among academic medical centers with regard to who performs and interprets these studies, with different levels of cardiology fellow involvement in scanning and/or interpreting. On-call echocardiographic interpretation can be educationally valuable for cardiologists in training but may come at the expense of patient care. The aim of this study was to examine the agreement of preliminary fellows' interpretations of weekend on-call transthoracic echocardiograms with official attending cardiologists' interpretations. Methods: Cardiology fellows perform preliminary interpretations of sonographer-obtained echocardiograms obtained on weekends, with final reports performed by attending cardiologists the following business day. In this study, 358 consecutive echocardiograms obtained on weekends over a 12-month period were reviewed. Discrepancies between the preliminary and final interpretations were categorized as either major (diagnoses with implications for urgent change in management) or minor (diagnoses without such implications). All discrepancies were also categorized as a missed diagnosis, an overcall (of severity), or an undercall. Results: No preliminary interpretation was identified in 18.4% of the studies (66 of 358). Of the remaining on-call echocardiograms (n = 292), the overall discrepancy rate in interpretations between fellows and attending cardiologists was 16.8%. Out of these, the minor discrepancy rate was 14.4% (42 of 292), and the major discrepancy rate was 2.4% (seven of 292). Misses, overcalls, and undercalls accounted for 29%, 31%, and 40% of all discrepancies, respectively. Conclusions: The results indicate that although minor discrepancies between fellows' and attending cardiologists' interpretations were common (14.4%), major discrepancies were uncommon (2.4%) and similar to major discrepancy rates from the radiology literature. In general, discrepant interpretations were more likely to result from changes in severity, but misses accounted for almost all of the major discrepancies. Further research is needed to compare the clinical impact of different models of on-call echocardiographic services.
MeSH term(s)	Academic Medical Centers ; Cardiology/education ; Echocardiography ; Education, Medical, Graduate/methods ; Female ; Humans ; Internship and Residency ; Male ; Retrospective Studies ; Washington
Language	English
Publishing date	2017-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/j.echo.2017.07.014
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