26-A-7633-ACC COMPARATIVE CARDIOVASCULAR CARE IN CALIFORNIA: PROCEDURE VOLUMES, PAYER MIX, AND OUTCOMES ACROSS KAISER AND NON-KAISER HOSPITALS

Journal of the American College of Cardiology · 2026-03-27

NECK DISSECTION LEADING TO PLATYPNEA-ORTHODEOXIA SYNDROME WITH RESOLUTION FOLLOWING PATENT FORAMEN OVALE CLOSURE

Journal of the American College of Cardiology · 2025-03-30

Novel automated electronic medical record-based VEST (virtual echocardiography screening tool) algorithm for pulmonary arterial hypertension

American Heart Journal · 2025-04-07

BACKGROUND: Pulmonary arterial hypertension (PAH) remains underrecognized and life-threatening due to limited awareness, nonspecific symptoms, and late referral to accredited pulmonary hypertension (PH) centers. The previously validated virtual echocardiography screening tool (VEST) predicts PAH hemodynamics. The objectives of the present study were to determine if the novel automated electronic medical record (EMR)-based algorithm could accurately calculate VEST scores to identify PAH hemodynamics and aid referral to PH specialty care. METHODS: This study is a retrospective analysis of 4,952 patients who underwent transthoracic echocardiogram (TTE) with tricuspid regurgitation velocity (TRV) ≥2.9 m/s in a hospital with an accredited PH Center of Comprehensive Care. Using the automated EMR-based algorithm, EMR-calculated VEST scores were calculated and compared to manually calculated VEST scores. Automated EMR VEST scores were used to identify those with highest risk for PAH (+3 score). Patients with +3 score were analyzed to determine whether they were evaluated within the accredited PH center or undergone right heart catheterization (RHC), the gold standard for PH diagnosis. RESULTS: Automated EMR VEST scores were validated with 100% correlation to 60 manual scores. Of 354 patients with +3 score, those that underwent RHC had severe PH, with mean pulmonary artery pressure 48 mm Hg and pulmonary vascular resistance 8.5 Wood units. One hundred and four patients (29.4%) were never referred for specialty PH care, and of these, only 37.5% underwent RHC. In the 250 patients referred to subspecialty PH care, 237 (94.8%) underwent RHC. CONCLUSIONS: This novel EMR-based automated VEST calculator is a powerful yet simple scoring tool that can capture patients at high risk for PAH, prompting earlier diagnosis and referrals to accredited PH centers to allow for earlier expert care and implementation of medical therapies.

Abstract 4144283: A Novel EMR-Based Algorithm with the Virtual Echocardiography Screening Tool (VEST) to Screen Patients for Pulmonary Arterial Hypertension

Circulation · 2024-11-12

Introduction: Pulmonary arterial hypertension (PAH) remains an underrecognized, fatal disease. Limited awareness, non-specific symptoms, and late referral to accredited PH centers all contribute to an overall poor prognosis. The previously validated Virtual Echocardiography Screening Tool (VEST) uses 3 routine transthoracic echocardiogram (TTE) parameters (left atrial size, transmitral E:e’ and systolic interventricular septal flattening) to recognize a high PAH likelihood. A positive VEST score has been shown to have 80% sensitivity and 76% specificity for PAH hemodynamics, while a VEST score of +3 has 92.7% specificity for PAH hemodynamics with a positive predictive value of 88.0%. Aim: We aimed to implement a novel algorithm via our electronic medical record (EMR) as an automated VEST calculator to identify patients with a high likelihood of PAH. Methods: An automated EMR VEST calculator was applied retrospectively to 4,952 patients who underwent TTE with TR velocity >/= 2.9 m/s at an accredited PH center from 12/2021-8/2023. Automated EMR VEST scores were validated by comparison to 60 manually scored echocardiograms. Those with VEST score of +3 (highest risk for PAH) underwent chart review to identify whether they were seen by a PH specialist. Results: There was 100% correlation between the automated EMR VEST scores and the manual results. Of the 4,952 patients, 1,655 had a positive automated EMR VEST score, and 355 had a score of +3, predicting the highest likelihood of PAH and warranting urgent referral to an accredited PH center. Of those patients with a +3 score, 103 (29.0%) were never seen by a PH specialist (Fig 1). Conclusion: VEST is a validated, noninvasive and accessible screening tool for identification of patients with a high likelihood of PAH likely to benefit from early referral to a PH center. We present a novel, accurate, and automated EMR algorithm for determination of the VEST score to prompt urgent referral for PH expert evaluation and timely initiation of complex medical therapies. These findings highlight the potential of future artificial intelligence and machine-learning applications for improved recognition of life-threatening PAH.

The Utility of Machine Learning for Cardiology and Cardiac Surgery Risk Assessment Scores

Indian Journal of Clinical Cardiology · 2024-06-12

Artificial intelligence (AI) has attracted great interest in the world of cardiology and cardiovascular surgery. For simplicity, AI has 3 distinct sectors: machine learning (ML), deep learning, and generative AI. In the case of ML, when calculating cardiovascular risk scores, ML algorithms analyze large, complex datasets (data mining) to predict the risk of morbidity and mortality.

The Pregnant Patient and the Cardiologist

JACC Case Reports · 2023-05-01

I am not afraid of storms for I am learning how to sail

Automated analysis of limited echocardiograms: Feasibility and relationship to outcomes in COVID-19

Frontiers in Cardiovascular Medicine · 2022-07-22 · 8 citations

Background: As automated echocardiographic analysis is increasingly utilized, continued evaluation within hospital settings is important to further understand its potential value. The importance of cardiac involvement in patients hospitalized with COVID-19 provides an opportunity to evaluate the feasibility and clinical relevance of automated analysis applied to limited echocardiograms. Methods: In this multisite US cohort, the feasibility of automated AI analysis was evaluated on 558 limited echocardiograms in patients hospitalized with COVID-19. Reliability of automated assessment of left ventricular (LV) volumes, ejection fraction (EF), and LV longitudinal strain (LS) was assessed against clinically obtained measures and echocardiographic findings. Automated measures were evaluated against patient outcomes using ROC analysis, survival modeling, and logistic regression for the outcomes of 30-day mortality and in-hospital sequelae. Results: Feasibility of automated analysis for both LVEF and LS was 87.5% (488/558 patients). AI analysis was performed with biplane method in 300 (61.5%) and single plane apical 4- or 2-chamber analysis in 136 (27.9%) and 52 (10.7%) studies, respectively. Clinical LVEF was assessed using visual estimation in 192 (39.3%), biplane in 163 (33.4%), and single plane or linear methods in 104 (21.2%) of the 488 studies; 29 (5.9%) studies did not have clinically reported LVEF. LV LS was clinically reported in 80 (16.4%). Consistency between automated and clinical values demonstrated Pearson's R, root mean square error (RMSE) and intraclass correlation coefficient (ICC) of 0.61, 11.3% and 0.72, respectively, for LVEF; 0.73, 3.9% and 0.74, respectively for LS; 0.76, 24.4ml and 0.87, respectively, for end-diastolic volume; and 0.82, 12.8 ml, and 0.91, respectively, for end-systolic volume. Abnormal automated measures of LVEF and LS were associated with LV wall motion abnormalities, left atrial enlargement, and right ventricular dysfunction. Automated analysis was associated with outcomes, including survival. Conclusion: Automated analysis was highly feasible on limited echocardiograms using abbreviated protocols, consistent with equivalent clinically obtained metrics, and associated with echocardiographic abnormalities and patient outcomes.

Impact of Racial Disparities in Preoperative Cardiovascular Evaluation and Surgical Outcomes in Patients Undergoing Metabolic and Bariatric Surgery: A Retrospective Cohort Analysis

Journal of the American Heart Association · 2022-05-28 · 4 citations

Background We investigated preoperative referral patterns, rates of cardiovascular testing, surgical wait times, and postoperative outcomes in White versus Black, Hispanic, or other racial or ethnic groups of patients undergoing metabolic and bariatric surgery. Methods and Results This was a single center retrospective cohort analysis of 797 consecutive patients undergoing metabolic and bariatric surgery from January 2014 to December 2018; 86% (n=682) were Black, Hispanic, or other racial or ethnic groups. White versus Black, Hispanic, or other racial or ethnic groups had similar baseline comorbidities and were referred for preoperative cardiovascular evaluation in similar proportion (65% versus 68%, P =0.529). Black, Hispanic, or other racial or ethnic groups of patients were less likely to undergo preoperative cardiovascular testing (unadjusted odds ratio [OR], 0.56; 95% CI, 0.33–0.95; P =0.031; adjusted for Revised Cardiac Risk Index OR, 0.59; 95% CI, 0.35–0.996; P =0.049). White patients had a shorter wait time for surgery (unadjusted hazard ratio [HR], 0.7; 95% CI, 0.58–0.87; P =0.001; adjusted HR, 0.7; 95% CI, 0.56–0.95; P =0.018). Reduction in body mass index at 6 months was greater in White patients (12.9 kg/m 2 versus 12.0 kg/m 2 , P =0.0289), but equivalent at 1 year (14.9 kg/m 2 versus 14.3 kg/m 2 , P =0.330). Conclusions White versus Black, Hispanic, or other racial or ethnic groups of patients were referred for preoperative cardiovascular evaluation in similar proportion. White patients underwent more preoperative cardiac testing yet had a shorter wait time for surgery. Early weight loss was greater in White patients, but equivalent between groups at 12 months.

FULLY AUTOMATED ANALYSIS OF CARDIAC POINT OF CARE ULTRASOUND: FEASIBILITY AND CLINICAL RELEVANCE IN COVID-19 PATIENTS.

Journal of the American College of Cardiology · 2022-03-01

Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Pacing and Clinical Electrophysiology · 2021-05-08 · 3 citations

Abstract Purpose Non‐white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown. Methods We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 and 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post‐procedure oral anticoagulation (OAC) use in whites versus non‐whites. Results Among 109 patients undergoing LAAO (45% white), whites had lower CHA 2 DS 2 VASc scores, on average, than non‐whites (4.0 vs. 4.8, p = .006). There was no difference in median time from index event (IE) or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non‐whites 13.7 months, p = .9; 1.9 vs. 1.8 months, p = .6, respectively), and there was no difference in procedural complications (whites 4% vs. non‐whites 5%, p = .33). After adjusting for CHA 2 DS 2 VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95% CI [0.9‐6.0], p = .07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA 2 DS 2 VASc score and GI bleed severity, whites had a nearly five‐fold odds of being discharged on OAC (OR 4.6, 95% CI [1‐21.8], p = 0.05). The association between race and discharge OAC was not mediated through income category (total mediation effect 19% 95% CI [‐.04‐0.11], p = .38). Conclusion Despite an increased prevalence of comorbidities amongst non‐whites, wait time for LAAO and procedural complications were similar in whites versus non‐whites. Among those with prior GI bleed, whites were nearly five‐fold more likely to be discharged on OAC than non‐whites, independent of income.