Overview of Adult Cardiovascular DiseaseSocial Security Administration Compassionate Allowances Outreach Hearing on
Cardiovascular Disease and Multiple Organ Transplants
November 9th 2010University of Maryland Baltimore County
Gaby Weissman MDWashington Hospital Center
Georgetown University HospitalAssistant Professor Clinical Medicine
Burden of CVD - Mortality
World Health Organization - https://apps.who.int/infobase/Mortality.aspx
Burden of CVD - Mortality
World Health Organization - https://apps.who.int/infobase/Mortality.aspx
Burden of CVD Risk Factors - Hypertension
American Heart Association - http://www.americanheart.org/downloadable/heart/1261003279882FS14HBP10.pdf
Burden of CVD Risk Factors - Diabetes Mellitus
American Heart Association - http://www.americanheart.org/downloadable/heart/1236357007811FS12DIAB08.pdf
Burden of CVD Risk Factors - Obesity
American Heart Association - http://www.americanheart.org/downloadable/heart/1236358025411OVRWGHT.pdf
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 2003;24:789-800.Uchechukwu K. et al. Diagnostic accuracy of Rb-82 myocardial perfusion. JACC;49:1052-58Nandalur KR. et al. Diagnostic performance of stress cardiac MRI- a meta analysis. JACC;50:1343-53.Accuracy Trial: Budoff MJ. et al. JACC 2008.CORE-64 Trial: Miller JM. et al. Circulation. 2007;116:2627-2633.
Evaluating IHD
Burden of CVD: Heart Failure
Lloyd-Jones D. et al Circulation. Published online Dec 15, 2008.
Burden of CVD: Heart Failure
Lloyd-Jones D. et al Circulation. Published online Dec 15, 2008.
Heart Failure : Common Causes
Dickstein K. et al . Eur Heart J 2008. 29, 2388-2442.
Heart Failure Classification
Heart Failure : Prognosis Based on Stage
Ammar KA et al . Circulation 2007 115, 1563-1570.
Heart Failure : BNP
Change in NT-Pro BNP predicts re-hospitalization
•Anatomy
•Heart Structure
•Coronary Anatomy/stenosis
•Function
• LVEF
•RVEF
•Coronary Flow
•Stress testing
•Exercise Capacity
•Stress testing
•Cardiopulmonary testing
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
Evaluating Heart Function
Prognosis - LVEF
Curtis JP et al J Am Coll Cardiol. 2003; 736-42.
Cardiopulmonary stress testing
Lavie CJ. et al Am J Cardiol. 2004; 93:588-593.
Prognosis - Exercise stress testing
Hsich E. et al Am J Cardiol. 2004; 93:588-593.
Heart Failure : Prognosis Models
Levy WC. et al. The Seattle heart failure model: prediction of survival in heart failure. Circulation. 2006;113:1424.
Heart Failure : Prognosis Models
Lee DS et al. Predicting mortality among patients hospitalized for heart failure. J Am Medical Association. 2003;290:2581-87.
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. 2009;54;1407-1424.2. Jacobson AF. et al. Myocardial Iodine-123 Meta-Iodobenzylguanidine Imaging and cardiac events in heart failure. J Am Coll Cardiol. 2010;55:2212-21.3. Cho GY. et al. Global 2-Dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol. 2009;54;618-24.