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Martin E Goldman

Publications and source records attributed to Martin E Goldman.

15 recordsLinked to original sources
PubMed2006

A pilot study of the clinical impact of hand-carried cardiac ultrasound in the medical clinic.

BACKGROUND: Small, hand-carried ultrasound devices have become widely available, making point-of-care echocardiograms (echos) accessible to all medical personnel as a means to augment and improve the increasingly inefficient physical examination. This study was designed to determine the clinical utility of hand-carried echo by medical residents in clinical decision making. METHODS: Nine residents underwent brief, practical echo training to perform and interpret a limited hand-carried echo as an integral component of their office examination. The residents' hand-carried echo consisting of four basic views to define left ventricular (LV) function and wall thickness, valvular disease, and any pericardial effusions was compared to one performed by a level III echocardiographer. RESULTS: Seventy-two consecutive medical clinic patients were enrolled with an average image acquisition time of 4.45 minutes. Residents obtained diagnostic images in 94% of the cases and interpreted them correctly 93% of the time. They correctly identified 92% of the major echo findings and 78% of the minor findings. Their diagnosis of LV dysfunction, valvular disease, and LV hypertrophy improved by 19%, 39%, and 14% with hand-carried echo compared to history and physical alone. Management decisions were reinforced in 76% and changed in 40% of patients with the use of hand-carried echo. CONCLUSION: This study demonstrates that it is possible to train medical residents to perform an effective and reasonably accurate hand-carried echo during their physical examination, which can impact clinical management.

Chi-Square Distribution↗
PubMed2006

A comparison of cardiologist and noncardiologist use of echocardiograms: implications for containing health care costs.

Echocardiography enables physicians to examine the heart noninvasively and provides a comprehensive evaluation of the cardiovascular system. However, because it is a relatively expensive procedure compared to an ECG or X-ray, it is crucial that "echo" be utilized appropriately and judiciously. Using a retrospective chart review, we sought to determine whether there are differences in concordance between the diagnoses and echo findings of cardiologists and those of other physicians. Due to cardiologists' greater knowledge of cardiophysiology and echocardiography, cardiologists were expected to have a higher concordance between patient diagnosis and echocardiogram findings when compared to noncardiology physicians. Randomly, 500 echo reports were assessed for diagnosis, reason for the echo, and whether the echo findings agreed with the diagnosis. Other criteria that were studied included whether there were additional, unanticipated findings and whether these findings were of major or minor importance. Concordance between cardiologist pre-test diagnosis and echo findings was found in 95 out of 175 tests (54%). Noncardiologist pre-test diagnosis concordance with echo findings was found in 117 out of 325 tests (36%) (p<0.0001). Thus, the c ardiologists were found to have a significantly higher concordance between diagnosis and findings on echocardiogram when compared to noncardiologist physicians.

Cardiology↗
PubMed2005

Immediate upright post-treadmill exercise echocardiographic imaging.

Using standard treadmill exercise techniques, it has been shown that postexercise echocardiographic imaging can be performed safely and effectively while a patient is still standing on the treadmill. Furthermore, upright imaging can be initiated earlier and completed at a higher heart rate than standard supine imaging. Patients who can ambulate but with decreased agility and maneuverability and who would otherwise have been denied treadmill tests may be eligible for upright poststress imaging.

Echocardiography↗
PubMed2005

Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients.

OBJECTIVE: This study was designed to assess the clinical applicability of a small, handheld, portable transthoracic echocardiography device by noncardiologist intensivists. DESIGN: Prospective, observational study. After 10 one-hour tutorials, intensivists performed a limited transthoracic echocardiography (TTE) (2-4 views, without Doppler or M-mode) examination with the 5.6-lb SonoHeart Echo System (SonoSite, Bethell, WA) on critically ill patients admitted to the surgical intensive care unit. After initial cardiac clinical assessment in 90 patients, a limited TTE was performed by an intensivist to assess left ventricular (LV) function and LV volume status. Each study was immediately reviewed and repeated by an echocardiographer to determine the technical quality of the TTE and the accuracy of the intensivist's interpretation. Data were analyzed and presented in proportions using descriptive statistics. SETTING: Surgical intensive care unit of an academic medical center. PARTICIPANTS: Ninety critically ill adult patients. INTERVENTIONS: After initial cardiac clinical assessment, a limited TTE was performed by an intensivist to assess LV size and function, to rule out significant pericardial effusions, and to estimate circulatory volume. RESULTS: Intensivists successfully performed a diagnostic limited TTE in 94% of patients and interpreted their studies correctly in 84%. Limited TTE provided new cardiac information and changed management in 37% of patients. TTE added useful information in an additional 47% of patients but did not alter immediate management. The mean "goal-directed TTE" acquisition time was 10.5 +/- 4.2 minutes. CONCLUSION: After a brief formal training in using this handheld echocardiographic system in intensive care unit patients, surgical intensivists successfully performed and correctly interpreted a limited TTE in critically ill patients. Limited TTE provided new information and altered management in a significant number of patients. This study supports incorporating bedside goal-directed, limited TTE into intensivists' training programs.

Adult↗
PubMed2005

Fabry disease: percutaneous transluminal septal myocardial ablation markedly improved symptomatic left ventricular hypertrophy and outflow tract obstruction in a classically affected male.

Fabry disease (alpha-galactosidase A deficiency) is an X-linked recessive lysosomal storage disease in which left ventricular hypertrophy (LVH) is common, and if severe, may mimic hypertrophic obstructive cardiomyopathy. Alcohol-induced percutaneous transluminal septal myocardial ablation (PTSMA) has been used as a safe and effective method to alleviate LVH obstruction in patients with hypertrophic obstructive cardiomyopathy (HCM). We describe a case of a classically affected Fabry 53-year-old male with symptomatic HCM (NYHA class III with exertional angina) who was treated with PTSMA. The procedure safely and effectively alleviated symptomatic left ventricular outflow tract obstruction at long-term follow-up, and the patient's NYHA classification was reduced to NYHA class I to II.

Cardiac Catheterization↗
PubMed2004

Age-related prevalence of cardiac valvular abnormalities warranting infectious endocarditis prophylaxis.

The goal of our study was to determine the prevalence of older patients with cardiac valvular abnormalities warranting endocarditis prophylaxis. We performed a retrospective analysis of 1,000 randomly selected echocardiograms (inpatients and outpatients) from our tertiary care institution. We found that the prevalence of valvular abnormalities increased significantly with age, and that 50% of patients > or =60 years of age warranted endocarditis prophylaxis using current guidelines. With the aging population of the United States and the negative consequences of widespread antibiotic prophylaxis, further investigation is needed to identify patients who are truly at risk for infectious endocarditis.

Adolescent↗
PubMed2003

Spontaneous echo contrast videodensity is flow-related and is dependent on the relative concentrations of fibrinogen and red blood cells.

OBJECTIVES: The purposes of the present study were to: 1) determine whether fibrinogen (Fg) is the plasma protein responsible for spontaneous echo contrast (SEC), and 2) investigate modulators of SEC. BACKGROUND: Spontaneous echo contrast has been linked to the development of thromboemboli. The blood products and their interaction responsible for SEC formation have not been fully elucidated. METHODS: Blood echogenicity was examined with the use of quantitative videodensitometry over a controlled range of flow velocities in an in vitro model. Human blood samples were analyzed in a manner to methodically eliminate individual blood components from whole blood to determine which components are responsible for the formation of SEC. RESULTS: The videodensity (VD) of whole blood was found to be flow-dependent, with higher VD at lower flow rates, and correlated with visually dense SEC. The following blood products produced faint VD values: washed red blood cells (wRBCs), platelet-depleted plasma, Fg, defibrinated plasma, wRBCs plus defibrinated plasma, and physiologic saline. The VD of wRBCs increased incrementally as increasing concentrations of Fg were added. At each hematocrit (Hct) range, as Fg concentration increased, the SEC became denser, and the VD level also increased until a plateau level was reached that was distinct for each Hct. The addition of sialic acid, which inhibits RBC-RBC aggregation, decreased the amount of SEC, even in the presence of Fg. CONCLUSION: These results demonstrated that Fg-mediated RBC aggregation may be responsible for SEC generation. Furthermore, a unique stoichiometric relationship exists between Fg and RBC concentrations that is necessary for blood echogenicity.

Adult↗
PubMed2003

Calcific aortic stenosis: new pathophysiologic insights and possible new medical therapy.

Aortic stenosis is a progressive disease of aging with serious complications. A common disease of the elderly, it may inexorably progress to stenosis. Recent retrospective studies have correlated risk factors commonly associated with coronary and vascular atherosclerosis with an accelerated rate of aortic valve stenosis. Although hydroxymethyl glutaryl co-enzyme A reductase inhibitor (statin) treatment therapy has been shown to delay the rate of progression of valvular aortic stenosis, the salutary mechanism of the statin may be cholesterol-lowering and/or anti-inflammatory. Further prospective studies are warranted to investigate the mechanism and medical therapy of aortic sclerosis and stenosis.

Aortic Valve Stenosis↗
PubMed2003

Eustachian valve thrombus:critical factor in outcome of venous thromboembolism.

This case report describes a patient with pulmonary embolism (PE) in whom transesophageal echocardiography showed a thrombus in the right atrium attached to the eustachian valve (EV). The EV is typically absent in the adult, but when present it is considered to be benign. It is an uncommon site for thrombus formation. This patient was treated with systemic anticoagulation.

Anticoagulants↗
PubMed2003

Can hand-carried ultrasound devices be extended for use by the noncardiology medical community?

Echocardiography (echo) is a powerful, noninvasive, inexpensive diagnostic imaging technique that provides important information in a variety of cardiovascular diseases. Echo provides rapid information regarding ventricular and valvular function in the clinical management of patients. Smaller, relatively inexpensive hand-carried cardiac ultrasound (HCU) devices have become commercially available, which can be used for diagnostic cardiac imaging. Because of their relative ease of use, portability, and affordable cost, these new hand-held systems have made point-of-care (bedside) echocardiography available to all medical personnel. The rate-limiting step to the widespread use of this technology is the lack of personnel with echo training at the immediate contact point with patients. Although extensive training and experience are needed to acquire and interpret a complete echo, training medical personnel to perform and interpret a limited echo (defined as a brief, diagnosis focused exam) may fully exploit the potential of echo as a point-of-care diagnostic tool and may be accomplished in a short period of time. Presently there are guidelines for independent competency in echocardiography and HCU echo established by several professional organizations and as a result of these rigorous guidelines, other noncardiology medical professionals who could practically derive the greatest benefit are discouraged and virtually precluded from utilizing echo during the initial encounter with the patient. However, there is now a growing body of literature in a diverse group of noncardiology medical personnel that demonstrates that it is possible to quickly and effectively train them to perform and interpret limited echocardiograms. Medical students, medical residents, cardiology fellows with limited experience, emergency department physicians, and surgical intensive care unit staff have all been evaluated after only brief, focused training periods, and investigators found that HCU echo provided important new information, changed therapeutic management, and was vastly superior to the physical exam alone with an acceptable overall level of accuracy. The contribution of echocardiography to the field of cardiovascular disease since its invention has been significant and the newer compact, portable, ultrasound systems have the potential to revolutionize the utilization and availability of echocardiography. To maximize integration of echo into medical practice, physicians and physician extenders could be trained to perform and interpret limited echo to complement their clinical examination and improve their diagnostic skills. The challenge is to provide practical training programs to assure competency in performing point of care echocardiograms.

Emergency Service, Hospital↗
PubMed2003

Patent foramen ovale: anatomy versus pathophysiology--which determines stroke risk?

This study investigated anatomic and pathophysiologic variables that may determine which patent foramen ovale (PFO) are associated with cerebrovascular accidents (CVAs). Anatomic features of a PFO have been identified as risk factors that predispose certain people to cryptogenic strokes (strokes of unknown cause). However, potential pathophysiologic variables that can determine the pressure gradient between left and right atria, which could influence the right-to-left shunt through a PFO, have not been examined. A retrospective study included 78 consecutive patients in whom PFOs were detected during routine transesophageal echocardiography examination. Group I included 36 patients with CVAs of unknown cause (cryptogenic stroke). Group II included 42 patients without CVAs whose PFOs were incidental findings. Anatomic features measured included separation and overlap between septum primum and septum secundum, interatrial septal motion, and the relative size of the right-to-left shunt with peripheral saline solution contrast injections. Pathophysiologic variables considered were those that could cause elevated left atrial pressure, thereby minimizing the right-to-left shunt.Patients with a clinical neurologic event (group I) had a larger right-to-left shunt volume of contrast bubbles than did patients with asymptomatic PFO (group II; P =.004). The size of the overlap between septum primum and septum secundum was less in patients from group I as compared with patients from group II (7.5 +/- 3.4 mm versus 9.9 +/- 6.0 mm; P =.026). However, other anatomic features of PFO that are determinants of the "opening" were not significantly different between the 2 groups. No statistically significant difference was found in the distance of the separation between septum primum and septum secundum (2.5 +/- 2.0 mm versus 1.9 +/- 1.6 mm; P = not significant). The prevalence of interatrial septal aneurysm was also similar between the 2 groups (28% versus 21%; P = not significant). However, the prevalence of variables that could potentially raise left atrial pressure was greater in patients without CVA as compared with those with a CVA (48% versus 14%; P =.01). In our study, anatomic features alone did not determine interatrial shunt size and pathophysiologic variables that could raise left atrial pressures did differentiate between patients with a PFO with a CVA/transient ischemic attack and those without it. Thus, both anatomic and pathophysiologic mechanisms should be considered in determination of the potential clinical significance of a PFO.

Adult↗
PubMedDate not supplied

Pulmonary hypertension in type 1 Gaucher's disease: genetic and epigenetic determinants of phenotype and response to therapy.

Type 1 Gaucher's disease (GD) is recognized for striking but unexplained phenotypic diversity. Rarely, severe pulmonary hypertension (PH) may occur in GD but its clinical spectrum, determinants or its response to enzyme replacement therapy (ERT)+/-vasodilators is not known. One hundred and thirty-four consecutive patients with Type 1 GD were screened to estimate right ventricular systolic pressure (RVSP) by Doppler echocardiography. Ninety-four patients were on ERT and 40 were untreated. Eight additional GD patients were studied that represented consecutive tertiary referrals with severe PH. Angiotensin converting enzyme (ACE) gene polymorphisms and acid beta-glucosidase gene (GBA) mutations were determined by DNA analysis. Mild, asymptomatic PH (RVSP>35<50 mmHg) was prevalent in Type 1 GD: 30% in untreated patients and 7.4% among patients receiving ERT (P<0.001). Splenectomy was strongly associated with severe, life-threatening PH: all patients with severe PH (RVSP 50-130 mmHg) were asplenic compared to only 31% of patients with RVSP<50 mmHg (Odds ratio [OR] 28.8, 95% CI 1.6-531.6, P<0.001). Other characteristics of patients presenting with severe PH were poor compliance to ERT (4/9 patients) or no ERT (5/9 patients), a family history of a sib with GD and PH (2/2 patients), an excess of ACE I allele (OR 2.3, 95% CI 1.1-4.9, P=0.034) and an excess of non-N370S GBA mutation (OR 6.0, 95% CI 1.1-33, P=0.003). Severe PH was ameliorated by ERT+/-vasodilators during 4.6+/-4.0 yr (range 1-12 yr) follow-up; three patients were initially considered for lung transplantation but improved such that they are no longer active transplant candidates. Our study reveals a remarkable predisposition for PH in type 1 GD. Progression to severe, life-threatening PH occurs in the presence of additional genetic factors (non-N370S GBA mutation, positive family history, and ACE I gene polymorphism) and epigenetic modifiers (i.e., asplenia and female sex). Splenectomy should be avoided and in high-risk patients, ERT+/-vasodilators/coumadin should be initiated.

Adult↗