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  1. Article ; Online: Assessment of lifestyle "vital signs" in healthcare settings.

    Rozanski, Alan / Sakul, Sakul / Narula, Jagat / Berman, Daniel

    Progress in cardiovascular diseases

    2023  Volume 77, Page(s) 107–118

    Abstract: Unhealthy lifestyles, such as maintenance of poor diets and physical inactivity, are a powerful driver of disease-producing risk factors and chronic illnesses. This has led to an increasing call to assess adverse lifestyle factors in healthcare settings. ...

    Abstract Unhealthy lifestyles, such as maintenance of poor diets and physical inactivity, are a powerful driver of disease-producing risk factors and chronic illnesses. This has led to an increasing call to assess adverse lifestyle factors in healthcare settings. This approach could be aided by designating health-related lifestyle factors as "vital signs" that can be recorded during patient visits. Just such an approach has been used for assessing patients' smoking habits since the 1990s. In this review, we assess the rationale for addressing six other health-related lifestyle factors, beyond smoking, in patient care settings: physical activity (PA), sedentary behavior (SB), participation in muscle strengthening exercises, mobility limitations, diet, and sleep quality. For each domain, we evaluate the evidence that supports currently proposed ultra-short screening tools. Our analysis indicates strong medical evidence to support the use of one to two-item screening questions for assessing patients' PA, SB, muscle strengthening activities, and presence of "pre-clinical" mobility limitations. We also present a theoretical basis for measuring patients' diet quality through use of an ultrashort dietary screen, based on evaluation of healthy food intake (fruits/vegetables) and unhealthy food intake (high consumption of highly processed meats and/or consumption of sugary foods and beverages) and a proposed evaluation of sleep quality using a single-item screener. The result is a 10-item lifestyle questionnaire that is based on patient self-report. As such, this questionnaire has the potential to be employed as a practical tool for assessing health behaviors in clinical care settings without impairing the normal workflow of healthcare providers.
    MeSH term(s) Humans ; Delivery of Health Care ; Diet ; Feeding Behavior ; Life Style ; Mobility Limitation ; Vital Signs
    Language English
    Publishing date 2023-02-26
    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.2023.02.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 229: Show issues Location:
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  2. Article ; Online: Assessment of lifestyle-related risk factors enhances the effectiveness of cardiac stress testing.

    Rozanski, Alan / Sakul, Sakul / Narula, Jagat / Uretsky, Seth / Lavie, Carl J / Berman, Daniel

    Progress in cardiovascular diseases

    2023  Volume 77, Page(s) 95–106

    Abstract: Cardiac stress tests have been widely utilized since the 1960s for the diagnostic and prognostic assessment of patients with suspected coronary artery disease (CAD). Clinical risk is primarily based on assessing the presence and magnitude of inducible ... ...

    Abstract Cardiac stress tests have been widely utilized since the 1960s for the diagnostic and prognostic assessment of patients with suspected coronary artery disease (CAD). Clinical risk is primarily based on assessing the presence and magnitude of inducible myocardial ischemia. However, the primary factors driving mortality risk have changed over recent decades. Factors such as typical angina and inducible ischemia have decreased, whereas the percentage of patients with diabetes, obesity and hypertension have increased. There has also been a marked temporal increase in the percentage of patients who require pharmacologic testing due to inability to perform treadmill exercise at the time of cardiac stress testing and this need has emerged as the most potent predictor of mortality risk in contemporary stress test populations. However, the long-term clinical risk posed by the inability to perform exercise and concomitant CAD risk factors are rarely reflected in the assessment of patients' prognostic risk in cardiac stress test reports. In this review, we suggest that the clinical utility of present-day cardiac stress testing can be improved by developing a more comprehensive assessment that integrates and reports all factors which modulate patients' long-term clinical risk following stress and testing. This should include assessment of patients' CAD risk factors, physical activity habits and mobility risks, and identification of the reasons why patients could not exercise at the time of cardiac stress testing. In addition, the assessment of four core non-aerobic functional parameters should be considered among patients who cannot exercise: assessment of gait speed, handgrip strength, lower extremity strength, and standing balance.
    MeSH term(s) Humans ; Exercise Test ; Hand Strength ; Risk Assessment ; Coronary Artery Disease/diagnosis ; Risk Factors
    Language English
    Publishing date 2023-03-16
    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.2023.03.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The relationship between mitral regurgitant severity, symptoms, and exercise capacity in primary degenerative mitral regurgitation.

    Uretsky, Seth / Aldaia, Lillian / Marcoff, Leo / Koulogiannis, Konstatinos / Ignacio, Jonathan / Vegh, Andrea / Sakul, Sakul / Gillam, Linda D

    The international journal of cardiovascular imaging

    2023  Volume 39, Issue 9, Page(s) 1677–1685

    Abstract: Although it is assumed that more severe MR is associated with a greater burden of symptoms and lower exercise capacity, the relationship between symptoms, exercise capacity, and mitral regurgitant severity has not been well studied. We prospectively ... ...

    Abstract Although it is assumed that more severe MR is associated with a greater burden of symptoms and lower exercise capacity, the relationship between symptoms, exercise capacity, and mitral regurgitant severity has not been well studied. We prospectively studied 67 (63 ± 11 years, 72% male) patients with at least mild degenerative MR and left ventricular ejection fraction ≥ 50% who underwent stress echocardiography, CMR, and evaluation with the Kansas City Cardiomyopathy questionnaire (KCCQ). Symptoms and exercise capacity were evaluated in the context of MR severity. Patients reporting dyspnea had lower KCCQ symptom scores (79 ± 23 vs. 96 ± 9, p = 0.01) and achieved lower percentage of age and gender predicted METs (114 ± 37 vs. 152 ± 43%, p < 0.001) compared to those without dyspnea. There was no significant difference in MR volume between those with vs. without dyspnea by CMR (43 ± 26 ml vs. 51 ± 28 ml, p = 0.3) or echocardiography (64 ± 28 vs. 73 ± 41ml, p = 0.4). Those with severe MR by CMR had similar KCCQ symptom scores (96 ± 10 vs. 89 ± 17, p = 0.04) and percentage of age and gender predicted METs (148 ± 42 vs. 133 ± 47%, p = 0.2) to those without severe MR. Those with severe MR by echocardiography had similar KCCQ symptom score (93 ± 15 vs. 89 ± 16, p = 0.3) and percentage of age and gender predicted METs (138 ± 43 vs. 153 ± 46%, p = 0.2) to those without severe MR. Patients with degenerative MR assessed by CMR and stress echocardiography, there was no relationship between MR severity and either symptoms or exercise capacity. These findings highlight the disconnect between symptoms and the severity of MR and challenge the assumption that correcting MR can be counted on to improve symptom status in patients with degenerative MR.
    MeSH term(s) Humans ; Male ; Female ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/complications ; Stroke Volume ; Ventricular Function, Left ; Exercise Tolerance ; Predictive Value of Tests ; Severity of Illness Index
    Language English
    Publishing date 2023-06-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2055311-0
    ISSN 1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
    ISSN (online) 1875-8312 ; 1573-0743
    ISSN 1569-5794 ; 0167-9899
    DOI 10.1007/s10554-023-02881-3
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  4. Article ; Online: Increasing frequency of dyspnea among patients referred for cardiac stress testing.

    Rozanski, Alan / Gransar, Heidi / Sakul, Sakul / Miller, Robert J H / Han, Donghee / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S

    Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

    2023  Volume 30, Issue 6, Page(s) 2303–2313

    Abstract: Objective: To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing.: Patients and methods: We evaluated the prevalence of dyspnea and its relationship to ... ...

    Abstract Objective: To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing.
    Patients and methods: We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question. Patients were divided into three temporal groups.
    Results: The overall prevalence of dyspnea in our cohort was 30.2%. However, there was a stepwise increase in the temporal prevalence of dyspnea, which was present in 25.6% of patients studied between 2002 and 2006, 30.5% of patients studied between 2007 and 2011, and 38.7% of patients studied between 2012 and 2017. There was a temporal increase in the prevalence of dyspnea in each age, symptom, and risk factor subgroup. The adjusted hazard ratio for mortality was higher among patients with dyspnea vs those without dyspnea both among all patients, and within each chest pain subgroup.
    Conclusions: Dyspnea has become increasingly prevalent among patients referred for cardiac stress testing and is now present among nearly two-fifths of contemporary cohorts referred for stress-rest SPECT-MPI. Prospective study is needed to standardize the assessment of dyspnea and evaluate the reasons for its increasing prevalence.
    MeSH term(s) Humans ; Exercise Test/adverse effects ; Chest Pain/diagnosis ; Prognosis ; Tomography, Emission-Computed, Single-Photon/adverse effects ; Dyspnea/diagnosis ; Dyspnea/etiology ; Myocardial Perfusion Imaging/adverse effects ; Coronary Artery Disease/complications
    Language English
    Publishing date 2023-10-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1212505-2
    ISSN 1532-6551 ; 1071-3581
    ISSN (online) 1532-6551
    ISSN 1071-3581
    DOI 10.1007/s12350-023-03375-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Characterization of Primary Mitral Regurgitation With Flail Leaflet and/or Wall-Impinging Flow.

    Uretsky, Seth / Morales, Donna Chelle V / Aldaia, Lillian / Mediratta, Anuj / Koulogiannis, Konstantinos / Marcoff, Leo / Sakul, Sakul / Wolff, Steven D / Gillam, Linda D

    Journal of the American College of Cardiology

    2021  Volume 78, Issue 25, Page(s) 2537–2546

    Abstract: Background: Echocardiography guidelines note that a flail leaflet is a specific criterion for severe mitral regurgitation (MR) and that regurgitant severity is underestimated in wall-impinging jets (Coandă effect). Both findings are often considered to ... ...

    Abstract Background: Echocardiography guidelines note that a flail leaflet is a specific criterion for severe mitral regurgitation (MR) and that regurgitant severity is underestimated in wall-impinging jets (Coandă effect). Both findings are often considered to be pathognomonic of severe MR.
    Objectives: In this study, the authors sought to determine the association of flail leaflet and Coandă effect with MR severity quantified by means of cardiac magnetic resonance (CMR).
    Methods: The authors enrolled 158 consecutive patients with primary MR according to echocardiography and CMR. The presence of a flail leaflet or Coandă was determined for each patient. CMR regurgitant volume (RV) and regurgitant fraction (RF) were quantified for all patients.
    Results: There were 55 patients (35%) with a flail leaflet, 52 (33%) with Coandă, and 22 (14%) with a flail leaflet and Coandă. The mean CMR mitral RV and RF progressively increased in patients without a Coandă or flail, a Coandă, a flail, or a Coandă and a flail (RV: 28 ± 21 mL vs 43 ± 23 mL vs 58 ± 29 mL vs 64 ± 25 mL [P < 0.001]; RF: 25% ± 16% vs 34% ± 14% vs 41% ± 12% vs 45% ± 12% [P < 0.001]). With the use of CMR RV, 35%, 46%, and 59% of patients had severe MR with the presence of a Coandă, flail leaflet, or both, respectively. With the use of CMR RF, 25%, 31%, and 40% of patients had severe MR with the presence of a Coandă, flail leaflet, or both, respectively.
    Conclusions: While the presence of a flail leaflet and Coandă effect on echocardiography are associated with higher regurgitant volumes and fractions, they are frequently not associated with severe MR as assessed by means of CMR. (Comparison Study of Echocardiography and Cardiovascular Magnetic Resonance Imaging in the Assessment of Mitral and Aortic Regurgitation; NCT04038879).
    MeSH term(s) Aged ; Algorithms ; Cardiac Imaging Techniques ; Echocardiography ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging ; Mitral Valve Insufficiency/diagnostic imaging ; Prospective Studies ; Severity of Illness Index
    Language English
    Publishing date 2021-12-17
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2021.09.1382
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: American Society of Echocardiography Algorithm for Degenerative Mitral Regurgitation: Comparison With CMR.

    Uretsky, Seth / Animashaun, Islamiyat Babs / Sakul, Sakul / Aldaia, Lillian / Marcoff, Leo / Koulogiannis, Konstantinos / Argulian, Edgar / Rosenthal, Mark / Wolff, Steven D / Gillam, Linda D

    JACC. Cardiovascular imaging

    2022  Volume 15, Issue 5, Page(s) 747–760

    Abstract: Objectives: The purpose of this study was to compare the American Society of Echocardiography (ASE) algorithm for assessing mitral regurgitation (MR) to cardiac magnetic resonance (CMR) and left ventricular (LV) remodeling following mitral intervention.! ...

    Abstract Objectives: The purpose of this study was to compare the American Society of Echocardiography (ASE) algorithm for assessing mitral regurgitation (MR) to cardiac magnetic resonance (CMR) and left ventricular (LV) remodeling following mitral intervention.
    Background: The ASE recommends integrating multiple echocardiographic parameters for assessing MR. The ASE guidelines include an algorithm that weighs the parameters and highlights those considered indicative of definitely mild or definitely severe MR.
    Methods: We prospectively enrolled 152 (age 62 ± 13 years; 59% male) patients with degenerative MR who underwent ASE algorithm-guided echocardiographic and CMR grading of MR severity. Using the ASE algorithm, patients were graded as definitely mild, grade I, grade II, grade III, grade IV, or definitely severe MR. CMR MR volume was graded as mild (<30 mL), grade II moderate (30-44 mL), grade III moderate (45-59 mL), or severe (≥60 mL). A subgroup of 63 patients underwent successful mitral intervention, of whom 48 had postintervention CMR.
    Results: Only 52% of patients with definitely severe MR by the ASE algorithm had severe MR by CMR, and 10% had mild MR by CMR. There was an increase in post mitral intervention LV reverse remodeling with worsening MR severity using CMR (P < 0.0001) but not the ASE algorithm (P = 0.07). Severe MR by CMR was an independent predictor of post mitral intervention LV reverse remodeling and definitely severe MR by the ASE algorithm was not.
    Conclusions: In patients with degenerative MR, agreement between CMR and the ASE algorithm was suboptimal. Severe MR by CMR was an independent predictor of post mitral intervention LV reverse remodeling, whereas definitely severe MR by the ASE algorithm was not. These findings suggest an important role for CMR in surgical decision making in degenerative MR. (Comparison Study of Echocardiography and Cardiovascular Magnetic Resonance Imaging in the Assessment of Mitral and Aortic Regurgitation; NCT04038879).
    MeSH term(s) Aged ; Algorithms ; Echocardiography ; Female ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Mitral Valve Insufficiency ; Predictive Value of Tests ; Severity of Illness Index ; United States ; Ventricular Remodeling
    Language English
    Publishing date 2022-01-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2491503-8
    ISSN 1876-7591 ; 1936-878X
    ISSN (online) 1876-7591
    ISSN 1936-878X
    DOI 10.1016/j.jcmg.2021.10.006
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