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Kyle W Klarich

Publications and source records attributed to Kyle W Klarich.

13 recordsLinked to original sources
PubMed2006

Giant coronary artery aneurysm causing superior vena cava syndrome and congestive heart failure.

Coronary artery aneurysms are defined as localized coronary artery dilations >1.5 times the diameter of the adjacent segments. In adults, they are commonly of atherosclerotic origin and are usually asymptomatic. This is the first case report of a coronary artery aneurysm causing superior vena cava syndrome and heart failure. Chest x-ray showed cardiomegaly, and transthoracic echocardiography showed a mass that was confirmed by transesophageal echocardiography, computed tomography, and coronary angiography. In conclusion, giant coronary artery aneurysms can cause superior vena cava syndrome.

Aged↗
PubMed2006

Determining myocardial viability in chronic ischemic left ventricular dysfunction: a prospective comparison of rest-redistribution thallium 201 single-photon emission computed tomography, nitroglycerin-dobutamine echocardiography, and intracoronary myocardial contrast echocardiography.

BACKGROUND: Detection of viable myocardium (VM) has important therapeutic implications for chronic ischemic left ventricular (LV) systolic dysfunction. We compared the ability of nitroglycerin-dobutamine echocardiography (NTG-DE), intracoronary myocardial contrast echocardiography (MCE), and rest-redistribution thallium 201 single-photon emission computed tomography (RRT-SPECT) to detect VM in this setting. METHODS: Patients with LV ejection fraction (LVEF) <40% and multivessel coronary disease suitable for revascularization underwent NTG-DE, MCE, RRT-SPECT, and radionuclide ventriculography to determine baseline LVEF. Myocardial contrast echocardiography was performed using intracoronary injection of Albunex. Patients who underwent revascularization had 3-month postprocedural radionuclide ventriculography and transthoracic echocardiography to assess functional recovery. RESULTS: Of 512 myocardial segments in the 32 patients studied, 309 were akinetic or dyskinetic at baseline. Nitroglycerin alone increased regional thickening in 20% of segments with contractile reserve. By RRT-SPECT, 93% of nitroglycerin-responsive segments were viable. Myocardial contrast echocardiography had up to 85% sensitivity and 74% specificity for detection of VM diagnosed by RRT-SPECT. In the 23 patients who underwent revascularization, 54% of akinetic segments showed improved contractility, and mean LVEF increased from 32% to 37% (P = .04). Sensitivities and specificities for detecting functional recovery were 95% and 37% for RRT-SPECT, up to 87% and 48% for MCE, and 63% and 83% for a biphasic response during NTG-DE. CONCLUSIONS: In patients with chronic ischemic LV dysfunction, RRT-SPECT had the highest sensitivity, and NTG-DE, the best specificity for detection of VM. Nitroglycerin facilitated detection of VM and may be a useful adjunct to dobutamine stimulation.

Aged↗
PubMed2005

Prognosis of patients with good exercise capacity and mildly abnormal exercise echocardiography results: identification of an at-risk subgroup.

BACKGROUND: Patients with good exercise capacity and mildly abnormal exercise echocardiography results have a favorable overall prognosis. OBJECTIVE: We sought to define subgroups that might be at higher risk. METHODS: We examined outcomes of 868 patients (women, > or = 5 metabolic equivalents; men, > or = 7 metabolic equivalents) with mild rest- or exercise-induced wall-motion abnormalities and evaluated potential predictors of time to cardiac death or nonfatal myocardial infarction (MI). RESULTS: Mean age was 64 +/- 10 years; 477 patients (55%) were men. Mean follow-up was 3.1 +/- 1.5 years; cardiac event rate was 1.2% per person-year. A history of MI was the only significant predictor (risk ratio, 3.9; 95% confidence interval, 1.9-7.8; P = .0001), with 1-, 3-, and 5-year event-free survival of 98.5% +/- 1.1%, 92.6% +/- 2.6%, and 83.3% +/- 5.1%, respectively (event rate, 3.4%). CONCLUSIONS: Patients with a history of MI have a higher annual cardiac event rate and may benefit from reevaluation, whereas no history of MI connotes a favorable prognosis.

Aged↗
PubMed2005

The role of the nurse in clinical echocardiography.

Echocardiography plays an important role in the practice of clinical cardiology. As echocardiographic practice has evolved, the addition of nursing personnel to the echocardiography team has enhanced the assessment and diagnosis of cardiovascular disease. Specifically, nurses monitor patients during transesophageal and stress examinations and establish intravenous access for sonicated saline, microsphere contrast, and medication administration. We describe the involvement of nurses in the practice of clinical echocardiography.

Cardiovascular Diseases↗
PubMed2005

Internal medicine resident education in the medical intensive care unit: the impact on education and patient care of a scheduling change for didactic sessions.

OBJECTIVE: Modifications in residency educational programs are needed to comply with the work-hour limitations introduced by the Accreditation Council for Graduate Medical Education. The objective of this study was to determine the impact of rescheduling critical care didactic sessions on medicine residents' education during their medical intensive care unit (MICU) rotation and on outcomes. DESIGN: A pilot program of nonrandomized design. SETTING: A graduate school of medicine. PATIENTS: All patients admitted during the study periods who authorized their medical records to be reviewed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We instituted a pilot program that replaced the daily traditional 1-hour post-rounds didactic session with an 8:00 am 30-min session, conducted before work rounds, on weekdays from July 2003 through December 2003. The residents' end-of-rotation examination scores were used to assess the impact on education. The pilot period residents' examination results were compared with the examination results from July 2002 through December 2002. To evaluate the effect on patient care, the Acute Physiology Score, Acute Physiology and Chronic Health Evaluation III score, and predicted and observed lengths of MICU and hospital stay of all patients during these two study periods were abstracted and compared. Forty-eight residents were included in each period of the study. The residents' performance on the examination at the end of MICU rotation improved when the didactic session was moved to 8:00 am (67.9 +/- 13.8 vs. 73.9 +/- 12.1; p = .0270). The statistically significant improvement was limited to the first-year residents. There were 751 and 903 patients, respectively, admitted to the MICU during the 2002 and 2003 study periods. There were no significant differences in Acute Physiology Score and Acute Physiology and Chronic Health Evaluation III score between patients admitted during the two study periods. The observed hospital mortality rate was lower during the second period. There were no statistically significant differences in the adjusted length of MICU and hospital stay between the two periods. CONCLUSION: Early morning didactic sessions improve the educational experience of internal medicine residents rotating in the MICU without compromising patient care.

Adult↗
PubMed2005

Introduction of a 14-hour work shift model for housestaff in the medical ICU.

STUDY OBJECTIVE: To describe the outcomes of switching housestaff from a traditional model of "long-call" every 4 days to a 14-h work-shift model in a medical ICU (MICU) over a 5-week pilot period. DESIGN: Retrospective comparison of a 5-week pilot period for a 14-h work-shift model vs a 4-month period for the traditional model. SETTING: The MICU of a tertiary medical center. PARTICIPANTS: A total of 626 patients admitted to the MICU and 34 internal medicine residents taking care of them. INTERVENTIONS: None. MEASUREMENTS: Severity-adjusted patient outcomes, housestaff performance on end-of-rotation examinations, and scheduled duty hours during the 5-week 14-h work-shift pilot period compared to a 16-week traditional nonpilot work period. RESULTS: There were no statistically significant differences in patients' adjusted mortality rates, hospital lengths of stay, or housestaff performance on end-of-rotation knowledge assessment examinations between the pilot and nonpilot periods. During the pilot period, each resident was scheduled to work for an average of 61.3 h weekly, and each fellow for 65.3 h weekly. In comparison, each resident and fellow was scheduled to work for an average of 73.3 h weekly during the nonpilot period. CONCLUSIONS: The 14-h work shift is a feasible option for housestaff rotation in the MICU. Although the power of our study to detect significant differences in mortality, length of stay, and educational outcomes was low, there was no evidence of compromised patient care or housestaff education associated with the 14-h shift model over the course of this 5-week pilot study.

Adult↗
PubMed2005

Atypical presentation of eosinophilic endomyocardial disease.

Idiopathic hypereosinophllic syndrome is classically defined as prolonged, unexplained peripheral eosinophilia in a patient presenting with evidence of end-organ damage. The heart is frequently Involved, resulting In eosinophilic endomyocardial disease and eventually restrictive cardlomyopathy. The mortality rate is high because of progressive heart failure or ventricular arrhythmias. We describe a patient who presented with a left ventricular apical thrombus without notable peripheral eosinophilia. Findings from clinical evaluation and extensive diagnostic testing, including right ventricular biopsy, were Inconclusive. Resection of the thrombus and subjacent endomyocardium revealed eosinophilic Infiltration of the endomyocardium, which led to the diagnosis of eosinophilic endomyocardial disease. Clinicians should be aware of the variable presentation of patients with eosinophil-associated endomyocardial disease so that affected patients may benefit from early diagnosis and treatment.

Aged↗
PubMed2003

Mechanical prosthetic valve-associated strands: Pathologic correlates to transesophageal echocardiography.

Echocardiographic detection of prosthetic valve-associated strands has previously been reported, but their clinical relevance is unclear. Limited data are available regarding the cause, composition, and natural history of these strands. This report presents the gross and histopathologic findings of an explanted mechanical prosthetic valve shown by transesophageal echocardiography to have several strands. The patient had not experienced prior neurologic symptoms. Potential causes of strand formation in various clinical settings are also discussed.

Aged↗
PubMed2002

Association of cholesterol levels, hydroxymethylglutaryl coenzyme-A reductase inhibitor treatment, and progression of aortic stenosis in the community.

OBJECTIVES: This study was designed to analyze the association among cholesterol levels, lipid-lowering treatment, and progression of aortic stenosis (AS) in the community. BACKGROUND: Aortic stenosis is a progressive disease for which there is no known medical treatment to prevent or slow progression. Despite plausible pathologic mechanisms linking hypercholesterolemia to AS progression, clinical studies have been inconsistent and affected by referral bias, and the role of lipid-lowering therapy is uncertain. METHODS: We determined the association between blood cholesterol levels and progression of native AS (assessed by Doppler echocardiography at baseline and at least six months later; mean interval, 3.7 +/- 2.3 years) in a community-based study of 156 patients (age 77 +/- 12 years; 90 men). Thirty-eight patients received statin treatment during follow-up. RESULTS: In untreated subjects, mean gradient increased from 22 +/- 12 mm Hg to 39 +/- 19 mm Hg, and aortic valve area (AVA) decreased from 1.20 +/- 0.35 cm(2) to 0.91 +/- 0.33 cm(2) (both p < 0.001). The annualized change in AVA was -0.09 +/- 0.17 cm(2)/year (-7% +/- 13%/year). Neither total cholesterol (r = -0.01, p = 0.92) nor low-density lipoprotein cholesterol (r = 0.01; p = 0.88) showed a significant correlation to AS progression. Nevertheless, progression of AS was slower in patients receiving statins compared with untreated patients (decrease in AVA -3 +/- 10% vs. -7 +/- 13% per year, respectively; p = 0.04), even when adjusted for age, gender, cholesterol, and baseline valve area (p = 0.04). The association of statin treatment with slower progression was confirmed when analysis was restricted to patients coming for a systematic follow-up (p=0.02). The odds ratio of AS progression with statin treatment was 0.46 (95% confidence interval, 0.21 to 0.96). CONCLUSIONS: In the community, progression of AS shows no trend of association with cholesterol levels. Statin treatment, however, is associated with slower progression, suggesting that the effects of statin treatment on progression of AS should be pursued with appropriate clinical trials.

Adolescent↗
PubMed2002

Iatrogenic cardiac papillary fibroelastoma: a study of 12 cases (1990 to 2000).

Cardiac papillary fibroelastoma (PFE) is a rare, benign, slow-growing tumor of the endocardium. Whether it represents a reactive tumoral lesion or a true neoplasm remains a matter of debate. However, an anecdotal association of PFEs with previous cardiac surgery has been reported. The current study was undertaken to determine the frequency and nature of iatrogenic events associated with PFEs and to provide a comprehensive review of the topic. The study group comprised 12 cases seen between 1990 and 2000, with specimens from 7 women and 5 men. Six developed postoperatively and 6 developed after thoracic irradiation. The 9 Mayo cases represented 18% of all surgically excised PFEs during the study period. The mean age at operation was 54 years (range, 29 to 79 years). The mean interval between the iatrogenic event and excision of the tumor was 18 years (range, 9 to 31 years). In 58% of cases, the presence of multiple tumors was either confirmed pathologically (41.7%) or strongly suggested by echocardiography (16.6%). Among patients who had undergone previous cardiac surgery, PFEs were found in the chamber closest to the procedure. Similarly, in patients who had received radiation therapy, tumors developed in the left atrium, in the right ventricle and atrium, and on the tricuspid valve within the radiation field. In conclusion, iatrogenic PFEs may be relatively common among all such tumors, are frequently multiple, and often involve nonvalvular endocardial surfaces.

Adult↗