The Experts below are selected from a list of 36510 Experts worldwide ranked by ideXlab platform
Elizabeth A. Hahn - One of the best experts on this subject based on the ideXlab platform.
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Bedside Cardiovascular Examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension
Journal of the American College of Cardiology, 1993Co-Authors: Samuel M. Butman, Gordon A. Ewy, James R. Standen, Karl B. Kern, Elizabeth A. HahnAbstract:Abstract Objective. The aim of this study was to determine the sensitivity, speciticty and utility of the Cardiovascular Examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure. Background. Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned. Methods. We prospectively recorded the history, Cardiovascular physical signs present at bedside Examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function. Results. Pulmonary rates, a left ventricular third heart sound, jugular venous distension and the abdominojugular test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (≥8 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present. Conclusions. The bedside Cardiovascular Examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdomino-jugular test is simple and highly sensitive and specific in assessing left heart pressures in these patients.
Warrick J. Inder - One of the best experts on this subject based on the ideXlab platform.
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the third case of cabergoline associated valvulopathy the value of routine Cardiovascular Examination for screening
Journal of the Endocrine Society, 2018Co-Authors: Carmela Caputo, David L. Prior, Warrick J. InderAbstract:A decade after the alarming association of cabergoline-associated valvulopathy (CAV) in Parkinson disease, only two confirmed cases have occurred in patients with prolactinoma. Routine screening for CAV by echocardiography has not proved to be of diagnostic utility, has several limitations, and is not widely practiced. We have previously highlighted the value of annual Cardiovascular Examination as a screening tool for CAV in patients with prolactinoma. We present a case, now the third confirmed case of CAV, to highlight the value of the Cardiovascular Examination. A 52-year-old woman with a 25-year history of macroprolactinoma had received multimodal treatment, including surgery, radiosurgery, and medical therapy. Her medical therapy initially consisted of bromocriptine, followed by cabergoline. The cabergoline dose was 6 mg weekly. In 2009, the cumulative dose was 3272 mg when an echocardiogram showed no evidence of valvular disease. A routine Cardiovascular Examination in the clinic detected a new murmur in 2016. The echocardiogram demonstrated new-onset mild to moderate aortic regurgitation, with a thickened and restricted valve consistent with CAV. The cumulative dose of cabergoline at that point was 4192 mg. Follow-up echocardiography at 6-month intervals showed progression to moderate to severe aortic regurgitation, which has since stabilized. Cabergoline therapy was weaned and stopped completely in April 2017. An annual Cardiovascular Examination is the best screening test for CAV and can change the course of a patient's treatment. Echocardiograms should be reserved for patients with a new-onset cardiac murmur or a high cumulative dose of cabergoline.
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The need for annual echocardiography to detect cabergoline-associated valvulopathy in patients with prolactinoma: a systematic review and additional clinical data
The lancet. Diabetes & endocrinology, 2014Co-Authors: Carmela Caputo, David L. Prior, Warrick J. InderAbstract:Present recommendations by the US Food and Drug Administration advise that patients with prolactinoma treated with cabergoline should have an annual echocardiogram to screen for valvular heart disease. Here, we present new clinical data and a systematic review of the scientific literature showing that the prevalence of cabergoline-associated valvulopathy is very low. We prospectively assessed 40 patients with prolactinoma taking cabergoline. Cardiovascular Examination before echocardiography detected an audible systolic murmur in 10% of cases (all were functional murmurs), and no clinically significant valvular lesion was shown on echocardiogram in the 90% of patients without a murmur. Our systematic review identified 21 studies that assessed the presence of valvular abnormalities in patients with prolactinoma treated with cabergoline. Including our new clinical data, only two (0·11%) of 1811 patients were confirmed to have cabergoline-associated valvulopathy (three [0·17%] if possible cases were included). The probability of clinically significant valvular heart disease is low in the absence of a murmur. On the basis of these findings, we challenge the present recommendations to do routine echocardiography in all patients taking cabergoline for prolactinoma every 12 months. We propose that such patients should be screened by a clinical Cardiovascular Examination and that echocardiogram should be reserved for those patients with an audible murmur, those treated for more than 5 years at a dose of more than 3 mg per week, or those who maintain cabergoline treatment after the age of 50 years.
Samuel M. Butman - One of the best experts on this subject based on the ideXlab platform.
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Bedside Cardiovascular Examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension
Journal of the American College of Cardiology, 1993Co-Authors: Samuel M. Butman, Gordon A. Ewy, James R. Standen, Karl B. Kern, Elizabeth A. HahnAbstract:Abstract Objective. The aim of this study was to determine the sensitivity, speciticty and utility of the Cardiovascular Examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure. Background. Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned. Methods. We prospectively recorded the history, Cardiovascular physical signs present at bedside Examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function. Results. Pulmonary rates, a left ventricular third heart sound, jugular venous distension and the abdominojugular test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (≥8 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present. Conclusions. The bedside Cardiovascular Examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdomino-jugular test is simple and highly sensitive and specific in assessing left heart pressures in these patients.
Carmela Caputo - One of the best experts on this subject based on the ideXlab platform.
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the third case of cabergoline associated valvulopathy the value of routine Cardiovascular Examination for screening
Journal of the Endocrine Society, 2018Co-Authors: Carmela Caputo, David L. Prior, Warrick J. InderAbstract:A decade after the alarming association of cabergoline-associated valvulopathy (CAV) in Parkinson disease, only two confirmed cases have occurred in patients with prolactinoma. Routine screening for CAV by echocardiography has not proved to be of diagnostic utility, has several limitations, and is not widely practiced. We have previously highlighted the value of annual Cardiovascular Examination as a screening tool for CAV in patients with prolactinoma. We present a case, now the third confirmed case of CAV, to highlight the value of the Cardiovascular Examination. A 52-year-old woman with a 25-year history of macroprolactinoma had received multimodal treatment, including surgery, radiosurgery, and medical therapy. Her medical therapy initially consisted of bromocriptine, followed by cabergoline. The cabergoline dose was 6 mg weekly. In 2009, the cumulative dose was 3272 mg when an echocardiogram showed no evidence of valvular disease. A routine Cardiovascular Examination in the clinic detected a new murmur in 2016. The echocardiogram demonstrated new-onset mild to moderate aortic regurgitation, with a thickened and restricted valve consistent with CAV. The cumulative dose of cabergoline at that point was 4192 mg. Follow-up echocardiography at 6-month intervals showed progression to moderate to severe aortic regurgitation, which has since stabilized. Cabergoline therapy was weaned and stopped completely in April 2017. An annual Cardiovascular Examination is the best screening test for CAV and can change the course of a patient's treatment. Echocardiograms should be reserved for patients with a new-onset cardiac murmur or a high cumulative dose of cabergoline.
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The need for annual echocardiography to detect cabergoline-associated valvulopathy in patients with prolactinoma: a systematic review and additional clinical data
The lancet. Diabetes & endocrinology, 2014Co-Authors: Carmela Caputo, David L. Prior, Warrick J. InderAbstract:Present recommendations by the US Food and Drug Administration advise that patients with prolactinoma treated with cabergoline should have an annual echocardiogram to screen for valvular heart disease. Here, we present new clinical data and a systematic review of the scientific literature showing that the prevalence of cabergoline-associated valvulopathy is very low. We prospectively assessed 40 patients with prolactinoma taking cabergoline. Cardiovascular Examination before echocardiography detected an audible systolic murmur in 10% of cases (all were functional murmurs), and no clinically significant valvular lesion was shown on echocardiogram in the 90% of patients without a murmur. Our systematic review identified 21 studies that assessed the presence of valvular abnormalities in patients with prolactinoma treated with cabergoline. Including our new clinical data, only two (0·11%) of 1811 patients were confirmed to have cabergoline-associated valvulopathy (three [0·17%] if possible cases were included). The probability of clinically significant valvular heart disease is low in the absence of a murmur. On the basis of these findings, we challenge the present recommendations to do routine echocardiography in all patients taking cabergoline for prolactinoma every 12 months. We propose that such patients should be screened by a clinical Cardiovascular Examination and that echocardiogram should be reserved for those patients with an audible murmur, those treated for more than 5 years at a dose of more than 3 mg per week, or those who maintain cabergoline treatment after the age of 50 years.
Gordon A. Ewy - One of the best experts on this subject based on the ideXlab platform.
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Bedside Cardiovascular Examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension
Journal of the American College of Cardiology, 1993Co-Authors: Samuel M. Butman, Gordon A. Ewy, James R. Standen, Karl B. Kern, Elizabeth A. HahnAbstract:Abstract Objective. The aim of this study was to determine the sensitivity, speciticty and utility of the Cardiovascular Examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure. Background. Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned. Methods. We prospectively recorded the history, Cardiovascular physical signs present at bedside Examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function. Results. Pulmonary rates, a left ventricular third heart sound, jugular venous distension and the abdominojugular test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (≥8 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present. Conclusions. The bedside Cardiovascular Examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdomino-jugular test is simple and highly sensitive and specific in assessing left heart pressures in these patients.