Overview of Adult Cardiovascular Disease Social Security Administration Compassionate Allowances Outreach Hearing on Cardiovascular Disease and Multiple Organ Transplants November 9th 2010 University of Maryland Baltimore County

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Overview of Adult Cardiovascular DiseaseSocial
Security Administration Compassionate Allowances
Outreach Hearing on Cardiovascular Disease and
Multiple Organ TransplantsNovember 9th
2010University of Maryland Baltimore County

• Gaby Weissman MD
• Washington Hospital Center
• Georgetown University Hospital
• Assistant Professor Clinical Medicine

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Burden of CVD - Mortality
World Health Organization - https//apps.who.int/i
nfobase/Mortality.aspx
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Burden of CVD - Mortality
World Health Organization - https//apps.who.int/i
nfobase/Mortality.aspx
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Burden of CVD Risk Factors - Hypertension
American Heart Association - http//www.americanhe
art.org/downloadable/heart/1261003279882FS14HBP10.
pdf
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Burden of CVD Risk Factors - Diabetes Mellitus
American Heart Association - http//www.americanhe
art.org/downloadable/heart/1236357007811FS12DIAB08
.pdf
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Burden of CVD Risk Factors - Obesity
American Heart Association - http//www.americanhe
art.org/downloadable/heart/1236358025411OVRWGHT.pd
f
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ACC/AHA/ASNC Guidelines for the clinical use of
cardiac radionuclide imaging 2003.Schinkel A,
et al. Noninvasive evaluation of ischemic heart
disease Eur Heart J 200324789-800.Uchechukwu
K. et al. Diagnostic accuracy of Rb-82
myocardial perfusion. JACC491052-58Nandalur
KR. et al. Diagnostic performance of stress
cardiac MRI- a meta analysis. JACC501343-53.Acc
uracy Trial Budoff MJ. et al. JACC
2008.CORE-64 Trial Miller JM. et al.
Circulation. 20071162627-2633.
Evaluating IHD
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Burden of CVD Heart Failure
Lloyd-Jones D. et al Circulation. Published
online Dec 15, 2008.
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Burden of CVD Heart Failure
Lloyd-Jones D. et al Circulation. Published
online Dec 15, 2008.
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Heart Failure Common Causes
Dickstein K. et al . Eur Heart J 2008. 29,
2388-2442.
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Heart Failure Classification
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Heart Failure Prognosis Based on Stage
Ammar KA et al . Circulation 2007 115, 1563-1570.
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Heart Failure BNP
Change in NT-Pro BNP predicts re-hospitalization
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Evaluating Heart Function

• Anatomy
• Heart Structure
• Coronary Anatomy/stenosis
• Function
• LVEF
• RVEF

• Coronary Flow
• Stress testing
• Exercise Capacity
• Stress testing
• Cardiopulmonary testing

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Evaluating Heart Function

• Tests of Anatomy
• Echo
• MRI
• CT
• Tests of coronary perfusion
• Stress nuclear
• Stress echo
• Stress MRI

• Tests of exercise capacity
• ETT
• CPET
• 6 minute walk

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Prognosis - LVEF
Curtis JP et al J Am Coll Cardiol. 2003 736-42.
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Cardiopulmonary stress testing
Lavie CJ. et al Am J Cardiol. 2004 93588-593.
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Prognosis - Exercise stress testing
Hsich E. et al Am J Cardiol. 2004 93588-593.
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Heart Failure Prognosis Models
Levy WC. et al. The Seattle heart failure model
prediction of survival in heart failure.
Circulation. 20061131424.
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Heart Failure Prognosis Models
Lee DS et al. Predicting mortality among patients
hospitalized for heart failure. J Am Medical
Association. 20032902581-87.
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Future of Testing in HF

• mIBG - Evaluation of the sympathetic nervous
  system
• cMR - fibrosis imaging
• Myocardial strain measurements

1. Karamitos TD. Et al. The role of
cardiovascular magnetic resonance imaging in
heart failure. J Am Coll Cardiol.
2009541407-1424. 2. Jacobson AF. et al.
Myocardial Iodine-123 Meta-Iodobenzylguanidine
Imaging and cardiac events in heart failure. J Am
Coll Cardiol. 2010552212-21. 3. Cho GY. et al.
Global 2-Dimensional strain as a new
prognosticator in patients with heart failure. J
Am Coll Cardiol. 200954618-24.