Publications by Year: 2025

BACKGROUND: Ultrasound enhancing agents (UEAs) are an important diagnostic tool for transthoracic or stress echocardiography (TTE/SE) but recent concerns have been raised about their safety in reports from individual health systems. As such, we aimed to identify if UEAs for TTE/SE are associated with serious adverse events within 2 days of administration.

METHODS AND RESULTS: All-payor nationwide claims from 11.4 million insured individuals across the United States, 2018 to 2022 were used to evaluate rates of death, anaphylaxis, myocardial infarction, ventricular tachycardia, or cardiac arrest within 2 days of TTE/SE among adults receiving and not receiving UEAs. Of the 11 421 463 individuals included (mean age 57.5±16.2, 54.0% female, 46.2% White), a total of 500 073 (4.4%) received TTE/SE with UEAs. After propensity score matching, the odds of death were lower in those receiving UEAs (receipt versus nonreceipt, 0.02% versus 0.14%, odds ratio [OR], 0.23 [95% CI, 0.19-0.28], P<0.001) and were not different across agents (Definity: 0.02%, OR, 0.22 [95% CI, 0.18-0.28]; Lumason: 0.03%, OR, 0.33 [95% CI, 0.20-0.57]; Optison: 0.01%, OR, 0.17 [95% CI, 0.08-0.38]; all P < 0.001). Rates of nondeath outcomes were similar to those observed in individuals not receiving UEAs, overall, and across specific agents. Rates of all outcomes were stable across years, including considering pre- and post-COVID periods.

CONCLUSIONS: In this large nationwide claims analysis from 2018 to 2022, serious adverse events associated with UEAs for TTE/SE were uncommon and overall consistent across agents and years of study. Compared with nonreceipt, receipt of UEAs was associated with a lower odds of death within 2 days of TTE/SE.

BACKGROUND: Aortic valve calcium (AVC) is associated with increased risk of mortality, cardiovascular disease (CVD), non-CVD such as dementia. Traditional atherosclerotic CVD risk factors are associated with both AVC and chronic kidney disease (CKD), but whether there is an association between AVC and CKD is unknown.

OBJECTIVES: To ascertain whether AVC quantified by cardiac CT scanning is independently associated with the long-term risk of incident CKD among individuals without a previous history of CVD.

METHODS: We examined 6346 Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent cardiac CT scanning at Visit 1 (2000-02) and had an eGFR of ≥ 60 mL/min/1.73 m2. AVC was quantified using the Agatston method and categorized as 0, 1-99, and ≥100. Incident CKD was defined as an eGFR < 60 mL/min/1.73 m2 accompanied with an at least 40 % decline in eGFR from baseline, and/or a diagnosis of CKD and indicators of end stage renal disease extracted from hospital records using the International Classification of Disease (ICD) codes. We performed Kaplan-Meier survival curve analyses along with multivariable adjusted Cox proportional hazard regression models to examine the association between AVC (categorical and log-transformed) and incident CKD.

RESULTS: Participants had a mean age 62.2 ± 10.1 years, 53 % were women, and AVC >0 was present in 795 (12 %) participants. During a median follow-up time of 16.9 years, 982 (15 %) participants developed incident CKD. AVC examined as a continuous variable was associated with a significantly increased risk of developing CKD (per log-unit [AVC+1] HR 1.06 [95 % CI: 1.02-1.10]; p = 0.005). Kaplan-Meier models showed a higher cumulative incidence for CKD with higher AVC levels. In the multivariable adjusted Cox models, participants with AVC ≥100 had a higher risk of incident CKD, compared with the AVC=0 group (HR 1.48 [95 % CI: 1.15-1.89]; p = 0.002). The observed associations remained after further adjusting for CAC score (p = 0.024), Lp(a) (p = 0.004), and the APOE-ε4 genotype (p = 0.004).

CONCLUSIONS: In a multi-ethnic cohort of participants free of CKD at baseline, AVC was independently associated with a higher risk of incident CKD. Further work is needed to understand the multidirectional relationship between AVC, CKD, and atherosclerosis.

PURPOSE OF REVIEW: To provide a contemporary update on the American Society of Echocardiography's ImageGuideEcho Registry and present a case study of an individual institution's experience with enrollment.

RECENT FINDINGS: Technical innovation in clinical echocardiography has expanded the impact of echocardiography in cardiovascular care and provides new opportunities to leverage clinical data to inform quality improvement initiatives and research. The ImageGuideEcho Registry is the first echocardiography-specific imaging registry in the United States and provides a data infrastructure for quality improvement and multicenter research. The ImageGuideEcho Registry continues to grow, offering a window into echocardiography care across the United States in a variety of practice settings. This early experience highlights its value, opportunities, and ongoing challenges. Continued innovation, such as the addition of primary images, will further add to the substantial value of the registry.

BACKGROUND: Abbreviation use in clinical and academic cardiology is widespread, yet there are few guidelines regulating the creation and utilization of abbreviations. Inconsistent abbreviations can introduce ambiguity and pose challenges to practice and research.

OBJECTIVES: The authors aimed to analyze how abbreviations are created and utilized in general cardiology and cardiac imaging society guidelines in order to assess whether ambiguities and discrepancies exist between societies.

METHODS: Abbreviation data were collected from 7 national and international societies of general cardiology and cardiac imaging over a 6-year span (2018-2023). Data were linguistically coded for abbreviation type, unique occurrence, meaning or sense count, and frequency of discrepancy between societies.

RESULTS: Among a total of 5,394 abbreviation tokens, there were 1,782 unique entries. Among the unique entries, 227 (12.7%) had 2 or more associated meanings (senses), and thus were potentially ambiguous. Cardiac societies differed from each other, and also internally, in their use of abbreviations, with the European Society of Cardiology representing the highest frequency of discrepant abbreviation usage (14.5%).

CONCLUSIONS: More than 12.7% of abbreviations in cardiology society guidelines had 2 or more corresponding meanings, potentially increasing the risks of miscommunication and misrepresentation. We call on cardiology and cardiac imaging societies to define and publish best practices regarding abbreviation creation and utilization.