Gaby Weissman MD Washington Hospital Center Georgetown University Hospital

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.