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Amil M. Shah - One of the best experts on this subject based on the ideXlab platform.

  • Association of Left Atrial Enlargement and Atrial Fibrillation With Cognitive Function and Decline: The ARIC-NCS.
    Journal of the American Heart Association, 2019
    Co-Authors: Michael J. Zhang, Faye L. Norby, Pamela L. Lutsey, Thomas H. Mosley, Rebecca Cogswell, Suma H Konety, Tze Fan Chao, Amil M. Shah, Scott D. Solomon, Alvaro Alonso
    Abstract:

    Background Atrial fibrillation (AF) is associated with cognitive decline. Whether Left Atrial Enlargement (LAE), a critical substrate for AF, is also associated is less well established. Therefore,...

  • cardiac structure and function in heart failure with preserved ejection fraction baseline findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial
    Circulation-heart Failure, 2014
    Co-Authors: Amil M. Shah, Sanjiv J Shah, John F Heitner, Nancy K Sweitzer, Inder S Anand, Susan F Assmann, Eileen Omeara, George Sopko, Guichu Li, Sonja M Mckinlay
    Abstract:

    Background —Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Methods and Results —Echocardiograms were obtained from 935 patients with HFpEF (Left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean Left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric Left ventricular remodeling (34%) and hypertrophy (43%), and Left Atrial Enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater Left ventricular hypertrophy and a higher prevalence of Left Atrial Enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions —Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including Left ventricular hypertrophy and Left Atrial Enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00094302][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00094302&atom=%2Fcirchf%2Fearly%2F2013%2F11%2F18%2FCIRCHEARTFAILURE.113.000887.atom

  • cardiac structure and function in heart failure with preserved ejection fraction baseline findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial
    Circulation-heart Failure, 2014
    Co-Authors: Amil M. Shah, Sanjiv J Shah, John F Heitner, Nancy K Sweitzer, Inder S Anand, Susan F Assmann, Eileen Omeara, George Sopko, Sonja M Mckinlay, Bertram Pitt
    Abstract:

    Background —Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Methods and Results —Echocardiograms were obtained from 935 patients with HFpEF (Left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean Left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric Left ventricular remodeling (34%) and hypertrophy (43%), and Left Atrial Enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater Left ventricular hypertrophy and a higher prevalence of Left Atrial Enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions —Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including Left ventricular hypertrophy and Left Atrial Enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00094302][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00094302&atom=%2Fcirchf%2Fearly%2F2013%2F11%2F18%2FCIRCHEARTFAILURE.113.000887.atom

Sonja M Mckinlay - One of the best experts on this subject based on the ideXlab platform.

  • cardiac structure and function in heart failure with preserved ejection fraction baseline findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial
    Circulation-heart Failure, 2014
    Co-Authors: Amil M. Shah, Sanjiv J Shah, John F Heitner, Nancy K Sweitzer, Inder S Anand, Susan F Assmann, Eileen Omeara, George Sopko, Guichu Li, Sonja M Mckinlay
    Abstract:

    Background —Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Methods and Results —Echocardiograms were obtained from 935 patients with HFpEF (Left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean Left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric Left ventricular remodeling (34%) and hypertrophy (43%), and Left Atrial Enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater Left ventricular hypertrophy and a higher prevalence of Left Atrial Enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions —Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including Left ventricular hypertrophy and Left Atrial Enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00094302][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00094302&atom=%2Fcirchf%2Fearly%2F2013%2F11%2F18%2FCIRCHEARTFAILURE.113.000887.atom

  • cardiac structure and function in heart failure with preserved ejection fraction baseline findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial
    Circulation-heart Failure, 2014
    Co-Authors: Amil M. Shah, Sanjiv J Shah, John F Heitner, Nancy K Sweitzer, Inder S Anand, Susan F Assmann, Eileen Omeara, George Sopko, Sonja M Mckinlay, Bertram Pitt
    Abstract:

    Background —Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Methods and Results —Echocardiograms were obtained from 935 patients with HFpEF (Left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean Left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric Left ventricular remodeling (34%) and hypertrophy (43%), and Left Atrial Enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater Left ventricular hypertrophy and a higher prevalence of Left Atrial Enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions —Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including Left ventricular hypertrophy and Left Atrial Enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00094302][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00094302&atom=%2Fcirchf%2Fearly%2F2013%2F11%2F18%2FCIRCHEARTFAILURE.113.000887.atom

Anthony N Demaria - One of the best experts on this subject based on the ideXlab platform.

  • value of a cardiovascular limited ultrasound examination using a hand carried ultrasound device on clinical management in an outpatient medical clinic
    American Journal of Cardiology, 2007
    Co-Authors: Bruce J Kimura, Stan A Amundson, David J Shaw, Donna L Agan, Andrew C Ping, Anthony N Demaria
    Abstract:

    Limited ultrasound imaging studies using hand-carried ultrasound devices at the point of care have individually shown feasibility in the detection of carotid atheroma, Left ventricular systolic dysfunction, Left Atrial Enlargement, and abdominal aortic aneurysm. To evaluate the utility of a specific cardiovascular limited ultrasound examination (CLUE) designed to detect all 4 entities in patients seen in an outpatient medical clinic. One hundred ninety-six patients underwent coronary heart disease risk stratification by National Cholesterol Education Program guidelines and CLUE with a hand-carried ultrasound device with cardiac and vascular transducers. CLUE included brief imaging of the carotid arteries, the heart, and the intra-abdominal aorta. The prevalence of abnormal CLUE results and their effect on clinical management were tabulated and stratified by coronary heart disease risk class. Patient age (mean ± SD) was 56 ± 14 years (range 22 to 95), and 32.1% were at low risk, 30.6% at intermediate risk, and 37.2% at high risk. Of the 196 CLUEs, abnormalities were present in 37.2% (32.7% had carotid atheroma, 3.1% had systolic dysfunction, 6.1% had Left Atrial Enlargement, and 1.0% had abdominal aortic aneurysm) and were related to age, increasing coronary heart disease risk, and male gender. Overall, CLUE resulted in new management recommendations in 20% of patients, primarily in coronary heart disease risk prevention. In patients at intermediate risk or aged 60 to 69 years, CLUE resulted in new recommendations in 39% and 37%, respectively. In conclusion, when applied to a clinic population, brief cardiovascular ultrasound exams frequently demonstrate unsuspected findings that can change management.

  • detection of Left Atrial Enlargement using hand carried ultrasound devices to screen for cardiac abnormalities
    The American Journal of Medicine, 2005
    Co-Authors: Bruce J Kimura, Steven J Fowler, Todd S Fergus, Joshua J Minuto, Stan A Amundson, Elizabeth A Gilpin, Anthony N Demaria
    Abstract:

    v u e t p t r Left Atrial Enlargement (LAE) is associated with both he presence and risk of many cardiac disorders and is otentially detectable by “point-of-care” ultrasound. This tudy evaluated Left atrium (LA) size as a marker of ardiac pathology and assessed a simple method to assist hysicians unfamiliar with echocardiography to detect AE with handheld ultrasound devices. We analyzed 500 utpatient echocardiography studies and stratified data by A size, patient age, physician referral, and presence of n abnormality. Prevalence, sensitivity, specificity, and ositive and negative predictive values for an abnormal chocardiogram were calculated at increasing LA size hresholds. After brief training, resident physicians (n 6) were tested on their ability to detect LA size greater han 40 mm on 13 video-looped images of the parasternal ong-axis view and then on 6 patient models. Of 500 chocardiography studies, the prevalence of an abnormal chocardiogram was higher when LA size was greater han 40 mm versus LA size of 40 mm or less (69% vs 9%, P .05) and was related to increasing LA size, lder age, and cardiologist referral. In the 13 test cases, ean resident accuracy was 92%, 79%, and 87% for etecting LA sizes 40 mm or less, greater than 40 mm, nd greater than 50 mm, respectively. On the 6 patient odels, residents averaged 82% overall accuracy. LA

Bertram Pitt - One of the best experts on this subject based on the ideXlab platform.

  • cardiac structure and function in heart failure with preserved ejection fraction baseline findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial
    Circulation-heart Failure, 2014
    Co-Authors: Amil M. Shah, Sanjiv J Shah, John F Heitner, Nancy K Sweitzer, Inder S Anand, Susan F Assmann, Eileen Omeara, George Sopko, Sonja M Mckinlay, Bertram Pitt
    Abstract:

    Background —Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Methods and Results —Echocardiograms were obtained from 935 patients with HFpEF (Left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean Left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric Left ventricular remodeling (34%) and hypertrophy (43%), and Left Atrial Enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater Left ventricular hypertrophy and a higher prevalence of Left Atrial Enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions —Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including Left ventricular hypertrophy and Left Atrial Enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00094302][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00094302&atom=%2Fcirchf%2Fearly%2F2013%2F11%2F18%2FCIRCHEARTFAILURE.113.000887.atom

George Sopko - One of the best experts on this subject based on the ideXlab platform.

  • cardiac structure and function in heart failure with preserved ejection fraction baseline findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial
    Circulation-heart Failure, 2014
    Co-Authors: Amil M. Shah, Sanjiv J Shah, John F Heitner, Nancy K Sweitzer, Inder S Anand, Susan F Assmann, Eileen Omeara, George Sopko, Guichu Li, Sonja M Mckinlay
    Abstract:

    Background —Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Methods and Results —Echocardiograms were obtained from 935 patients with HFpEF (Left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean Left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric Left ventricular remodeling (34%) and hypertrophy (43%), and Left Atrial Enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater Left ventricular hypertrophy and a higher prevalence of Left Atrial Enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions —Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including Left ventricular hypertrophy and Left Atrial Enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00094302][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00094302&atom=%2Fcirchf%2Fearly%2F2013%2F11%2F18%2FCIRCHEARTFAILURE.113.000887.atom

  • cardiac structure and function in heart failure with preserved ejection fraction baseline findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial
    Circulation-heart Failure, 2014
    Co-Authors: Amil M. Shah, Sanjiv J Shah, John F Heitner, Nancy K Sweitzer, Inder S Anand, Susan F Assmann, Eileen Omeara, George Sopko, Sonja M Mckinlay, Bertram Pitt
    Abstract:

    Background —Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Methods and Results —Echocardiograms were obtained from 935 patients with HFpEF (Left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean Left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric Left ventricular remodeling (34%) and hypertrophy (43%), and Left Atrial Enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater Left ventricular hypertrophy and a higher prevalence of Left Atrial Enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions —Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including Left ventricular hypertrophy and Left Atrial Enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00094302][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00094302&atom=%2Fcirchf%2Fearly%2F2013%2F11%2F18%2FCIRCHEARTFAILURE.113.000887.atom