Coronary Artery Disease: Jassal DS

Chow BJ, Larose E, Bilodeau S, Ellins ML, Galiwango P, Kass M, Sheth T, Jassal DS, Kirkpatrick ID, Mancini GB, Mayo J, Abraham A, White J. · Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada. · Can J Cardiol. · Pubmed #19279980 links to  free full text

This publication has no abstract.

Jassal DS, Neilan TG, Picard MH, Wood MJ. · Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Echocardiography. · Pubmed #17584197 No free full text.

Abstract: BACKGROUND: Abnormal tissue Doppler (TD)-derived indices during dobutamine stress echocardiography (DSE) can predict the presence of coronary artery disease (CAD) in patients with normal renal function. These indices include a reduction in annular systolic velocity (S'), a decrease in early diastolic annular velocity (E'), and prolongation of the time to E'. However, the ability of these indices to detect or exclude CAD in patients with chronic renal failure (CRF) is unclear. OBJECTIVE: To examine the ability of TD-derived indices to detect or exclude the presence of CAD in patients with CRF. METHODS: We evaluated a total of 30 patients (13 males, mean age 57 +/- 15 years) using both DSE and coronary angiography. This cohort consisted of 12 control patients with normal renal function (mean creatinine 0.5 mg/dL) and 18 patient with CRF (mean creatinine 2.5 mg/dL). At each stage of the DSE, left ventricular (LV) diastolic function was assessed using conventional (peak early (E) and late (A) transmitral, E/A ratio, E-wave deceleration time (DT), and isovolumic relaxation time (IVRT)) and TD-derived indices (lateral annular systolic (S'), early diastolic (E'), and late atrial velocities (A'), time to E' and E/E'). RESULTS: All 30 patients had a normal DSE based on systolic regional function and a normal coronary angiogram. There was no difference in E, A, E/A, DT or IVRT between the two groups at each stage. Despite normal coronaries, patients with CRF demonstrated lower S' and E' velocities at peak stress compared to the control patients (8.0 +/- 2.2 cm/sec vs 15.1 +/- 2.6, P < 0.05 and 6.7 +/- 1.6 cm/sec vs 13.3 +/- 3.1, P < 0.05, respectively). During DSE, the time to E' at peak stress in CRF patients was also prolonged compared to control (400 +/- 44 ms vs 329 +/- 51, P < 0.05). Patients with CRF also had increased filling pressures (as estimated by E/E') as compared to controls at peak stress (14.7 +/- 5.2 vs 7.4 +/- 1.5, P < 0.05, respectively). CONCLUSION: In patients with CRF, a reduction in TD derived indices does not predict the presence of obstructive CAD.

Nguyen T, Kumar K, Francis A, Walker JR, Raabe M, Zieroth S, Jassal DS. · Section of Cardiology, Department of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. · Cardiovasc Ultrasound. · Pubmed #19161596 links to  free full text

Abstract: Cardiac tamponade is the phenomenon of hemodynamic compromise caused by a pericardial effusion. Following a myocardial infarction, the most common causes of pericardial fluid include early pericarditis, Dressler's syndrome, and hemopericardium secondary to a free wall rupture. On transthoracic echocardiography, pericardial fluid appears as an echo-free space in between the visceral and parietal layers of the pericardium. Pericardial fat has a similar appearance on echocardiography and it may be difficult to discern the two entities. We present a case of a post-MI patient demonstrating pseudo tamponade physiology in the setting of excessive pericardial fat.

Kumar K, Menkis AH, Jassal DS, Arora RC. · Section of Cardiac Surgery, University of Manitoba, Cardiac Sciences Program, St. Boniface General Hospital, Manitoba, Canada. · Interact Cardiovasc Thorac Surg. · Pubmed #19074456 links to  free full text

Abstract: Iatrogenic acute aortic dissection is a rare, but well-known, potentially lethal complication following cardiac surgery. Iatrogenic acute aortic dissection in Marfan syndrome patients with normal aortic parameters has not been well studied. The location of the intimal tear, along the lesser curvature of the arch, poses the question if more attention should be given to this subgroup of patients. Due to their underlying aortic pathology and the nature of cardiac surgery, patients with Marfan syndrome will continue to be at greater risk than the average population.

Jassal DS, Shapiro MD, Neilan TG, Chaithiraphan V, Ferencik M, Teague SD, Brady TJ, Isselbacher EM, Cury RC. · Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, and the Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Invest Radiol. · Pubmed #17568273 No free full text.

Abstract: BACKGROUND: Recent advances in 64-slice multidetector computed tomography (MDCT) provide an opportunity to assess coronary artery disease, left ventricular function and, potentially, valvular heart disease. OBJECTIVE: To determine the ability of 64-MDCT to both detect and to quantify the severity of aortic regurgitation (AR), as compared with transthoracic echocardiography (TTE). METHODS: We evaluated a total of 64 patients (43 males, mean age 63+/-11 years), 30 with varying severities of AR as assessed by TTE and 34 matched controls. The severity of AR by TTE was determined using the vena contracta, the ratio of jet to left ventricular outflow tract (LVOT) height, and the ratio of the jet to LVOT cross-sectional area. AR by MDCT was defined as a lack of coaptation of the aortic valve leaflets in diastole and, if detected, the maximum anatomic aortic regurgitant orifice was determined. RESULTS: All 34 control patients without AR were correctly identified by MDCT. There were 14 patients with mild AR, 10 with moderate AR, and 6 with severe AR by TTE. Of these patients, MDCT correctly identified 21 patients with AR (sensitivity 70%, specificity 100%, positive predictive value [PPV] 100%, and negative predictive value [NPV] 79%). Anatomic regurgitant orifice area measured by MDCT correlated well with the TTE-derived vena contracta (r=0.79, P<0.001), ratio of jet to LVOT height (r=0.79, P<0.001), and ratio of jet to LVOT cross-sectional area (r=0.75, P<0.001). CONCLUSIONS: Direct planimetric measurement of the aortic valve anatomic regurgitant orifice area on 64-MDCT provides an accurate, noninvasive technique for detecting and quantifying AR.

Thakrar A, Shapiro MD, Jassal DS, Neilan TG, King ME, Abbara S. · Department of Internal Medicine, Royal University Hospital, Saskatoon, Canada. · Can J Cardiol. · Pubmed #17311121 links to  free full text

Abstract: A 44-year-old man with no known cardiac history presented with worsening dyspnea on minimal exertion. During follow-up, computed tomography angiography and echocardiography confirmed the incidental finding of cor triatriatum. As improvements in spatial and temporal resolution continue, cardiac computed tomography may become better suited to the dynamic imaging of anatomical defects in the heart, including, but not limited to, coronary artery disease.

Hataishi R, Rodrigues AC, Neilan TG, Morgan JG, Buys E, Shiva S, Tambouret R, Jassal DS, Raher MJ, Furutani E, Ichinose F, Gladwin MT, Rosenzweig A, Zapol WM, Picard MH, Bloch KD, Scherrer-Crosbie M. · Department of Anesthesia and Critical Care, Massachusetts General Hospital and Havard Medical School, Boston, MA 02114, USA. · Am J Physiol Heart Circ Physiol. · Pubmed #16443673 links to  free full text

Abstract: To learn whether nitric oxide (NO) inhalation can decrease myocardial ischemia-reperfusion (I/R) injury, we studied a murine model of myocardial infarction (MI). Anesthetized mice underwent left anterior descending coronary artery ligation for 30, 60, or 120 min followed by reperfusion. Mice breathed NO beginning 20 min before reperfusion and continuing thereafter for 24 h. MI size and area at risk were measured, and left ventricular (LV) function was evaluated using echocardiography and invasive hemodynamic measurements. Inhalation of 40 or 80 ppm, but not 20 ppm, NO decreased the ratio of MI size to area at risk. NO inhalation improved LV systolic function, as assessed by echocardiography 24 h after reperfusion, and systolic and diastolic function, as evaluated by hemodynamic measurements 72 h after reperfusion. Myocardial neutrophil infiltration was reduced in mice breathing NO, and neutrophil depletion prevented inhaled NO from reducing myocardial I/R injury. NO inhalation increased arterial nitrite levels but did not change myocardial cGMP levels. Breathing 40 or 80 ppm NO markedly and significantly decreased MI size and improved LV function after ischemia and reperfusion in mice. NO inhalation may represent a novel method to salvage myocardium at risk of I/R injury.