Citations

Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease. In clinical studies, it has been noted to have fewer side effects and similar image quality when compared to low-osmolar contrast media. This can be attributed to the pharmacological properties of iodixanol. These contrast agents are used for coronary computed tomography angiography and cardiac catheterization. In this article, the use, tolerability, and efficacy of iodixanol are reviewed, specifically evaluating the use of CCTA and coronary angiography, including outcome studies, randomized trials, and comparisons to other contrast agents.

Echocardiography (Echo) has a primary role in the evaluation of cardiac valve regurgitation. Echo valve regurgitation assessment includes multiple qualitative and quantitative methods which require adequate image quality, comprehensive echocardiographic images and precise measurements to obtain accurate assessment. For patient management, it is also important to investigate the mechanism of valve regurgitation. Severity and mechanism of valve regurgitation determine whether continued medical follow up is optimal or surgical or percutaneous valve repair, or replacement option should be necessary. Transthoracic Echo (TTE) is the gold standard most commonly used for the assessment of valve leaflet anatomy, valve motion and regurgitation severity to determine primary versus secondary causes of valve regurgitation, however transesophageal echo (TEE) provides high resolution imaging of valve leaflets and supporting apparatus and oftentimes determines mechanism of valve regurgitation particularly for mitral and tricuspid valves when TTE is unable to determine the mechanism. By providing surgical type views in a moving heart under normal hemodynamic conditions, 3D TEE has greatly improved assessment of mechanism and etiology of valve regurgitation. Besides, TEE also allows quantitation of valve regurgitation severity by Doppler methods as well as direct 3D planimetry of valve area and regurgitant orifice area. Doppler methods are pre and afterload dependent whereas direct 3D planimetry allows assessment of location and severity of valve regurgitation irrespective of ventricular loading conditions. Pre or intraoperative 3D TEE assessment can provide valuable information for surgical planning of valve repair or replacement. This review discusses various valvular pathologies causing regurgitation and the role of TTE and TEE in improving this assessment as shown by several case examples.

Abstract Introduction: Individuals with cancer may be at higher risk of atrial fibrillation (AF). However, sufficient data are lacking in AF risk among breast cancer survivors, especially for the mid-to long-term risk of AF and the impact of cancer treatment on this association. We aimed to investigate the risk of incident AF in women diagnosed with breast cancer and evaluate the association by length of follow-up and breast cancer treatment. Methods: Using the Korean Health Insurance Service database, we studied 96,476 women who were diagnosed with breast cancer (aged≥20 years) without prior history of AF and breast cancer and underwent breast cancer surgery between January 2007 and December 2013. They were matched 1:3 to a cancer-free population (n=289,428) based on birth year and sex and were followed to the end of 2018. Using ICD-10 codes (I48.0 to I48.4, I.48.9), AF was defined when it was a discharge diagnosis or was verified more than twice in an outpatient clinic. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of AF associated with breast cancer relative to the cancer-free population, adjusting for age, income, and comorbidities including diabetes, hypertension and hyperlipidemia. Results: During a median follow-up of 6.8 years, AF developed in 2,105 women with breast cancer (3.2 per 1,000 person-years). Mean age at baseline among participants was 49.6 years. Having breast cancer was associated with increased risk of AF (HR, 2.04; 95% CI, 1.93-2.15). This association was stronger for women aged <50 years (HR, 3.98; 95% CI, 3.59-4.40). When we repeated analyses with lag periods of two years to explore the possibility of reverse causation and mid-to long-term risk of AF (n=91,370), the association was largely attenuated but remained significant (HR, 1.18; 95% CI, 1.09-1.28 for total women and HR, 1.60; 95% CI, 1.38-1.86 for women aged <50 years). However, no increased risk of AF was observed in women with breast cancer aged >65 years. Compared with no use of anthracyclines and taxanes, respectively, ever use of anthracyclines and taxanes was associated with increased risk of AF after further adjusting for other cancer treatment modalities including use of trastuzumab, radiotherapy, and endocrine treatment (HR, 1.25; 95% CI, 1.12-1.40 and HR, 1.37; 95% CI, 1.23-1.53, respectively). This association persisted only among women with breast cancer ever treated with anthracyclines when analysis was limited to those with two year-lag periods (HR, 1.23; 95% CI, 1.04-1.45). Conclusions: In this large-scale nationwide cohort study in South Korea, women with breast cancer had an elevated risk of incident AF, especially for women with breast cancer younger than 50 years, regardless of the length of follow-up. Our findings also suggest that cardiotoxic side effects of cancer treatment such as use of anthracyclines might increase both short-term and mid-to long-term risk of AF among women with breast cancer. Citation Format: Yong-Moon ("Mark") Park, Wonyoung Jung, Yohwan Yeo, Sang Hyun Park, Ronda Henry-Tillman, Hong Seok Lee, Tasneem Z. Naqvi, Kyungdo Han, Dong Wook Shin. Risk of atrial fibrillation among women diagnosed with breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3214.

A 51-year-old unrestrained female driver with history of a high-speed motor vehicle accident had been followed due to progressively worsening tricuspid valve regurgitation (TR). Three dimensional (3D0 transesophageal echocardiogram (TEE) showed a TR jet through a perforation in the an avulsed anterior leaflet from the tricuspid valve and another central tricuspid TR jet regurgitation due to tricuspid leafletresulted from malcoaptation of the leaflets from tricuspid annulus annular dilatation.

Background: The 2017 ACC/AHA hypertension guidelines were released, and it specified blood pressure (BP) control goals in diverse situation. We will determine how the guideline can affect heart failure blood pressure control and risk factors for the control. There is not enough data how BP is controlled and what risk factors are related to controlled BP in heart failure patients according to the 2017 hypertension guideline. Method: 3276 heart failure patients who visited a community hospital for any medical reason were included and analyzed retrospectively from November 2017 to December 2018. Control of blood pressure will be defined based on the guidelines which show that heart failure patients’ blood pressure target is less than 130 /80 mmHg. ACE inhibitors/Aldosterone receptor blocker, diuretics(HCTZ, Furosemide, Butamex), Spironolactone, calcium channel blocker, and Angiotensin Receptor Neprilysin Inhibitor( Entresto), comorbidities(diabetes, chronic kidney disease, hyperlipidemia), age, gender, and ethnicities were collected and used for multi-variable adjusted logistic regression model. Results: 29.6% (555/1873) male patients were controlled based on the guidelines, on the contrary, 34.3%(482/1403) female patients revealed blood pressure control.The African american population’s BP was the most uncontrolled among all ethnicities. Multivariable logistic regression analysis was performed. Age of less than 65 years old [Odds ratio (OR): 2.81,95% Confidence Interval(CI): 2.41-3.26] was associated with controlled blood pressure. DM [OR: 0.71,95% CI: 0.61-0.82], beta-blocker [OR: 0.79,95% CI: 0.64-0.96] and LDL of more than 100mg/dl [OR: 0.57,95%, CI: 0.45-0.71] were noted to have significantly the uncontrolled BP. Conclusion: It appears about only one third of heart failure patients may be having their BP controlled based on 2017 ACC/AHA guideline. Beta-blocker were associated with uncontrolled blood pressure, which might suggest their dose of beta-blocker was not maximized for heart failure patients’ care. Clinicians may need to consider to try the higher dose if patients are tolerating. Elderly heart failure patients with DM or high LDL level (>100mg/dl)may need strict blood pressure control by better management of DM and LDL.

AbstractA previously healthy 49‐year‐old male patient presented with COVID‐19 infection and required mechanical ventilation and extracorporeal membrane oxygenation due to severe hypoxemia. Echocardiography showed cardiac dysfunction with an apical sparing strain pattern, which rapidly normalized within a week. Apical sparing myocardial strain in patients with COVID‐19 infection may suggest reverse‐type stress cardiomyopathy.