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Biomedical subjects

Ervin R Fox

Publications and source records attributed to Ervin R Fox.

7 recordsLinked to original sources
PubMed2006

The prognostic value of the mitral diastolic filling velocity ratio for all-cause mortality and cardiovascular morbidity in African Americans: the Atherosclerotic Risks in Communities (ARIC) study.

BACKGROUND: Although recent data suggest that the mitral diastolic early-to-late (E/A) ratio may be prognostic in selected population-based cohorts, its predictive value for morbidity and mortality in African Americans has not yet been well studied. METHODS: The study population consisted of African American participants from the Jackson cohort of the Atherosclerotic Risks in Community Study. Three subgroups of E/A ratios were defined: E/A <0.7, E/A 0.7-1.5, and E/A >1.5, using the middle group as reference. Cox proportional hazard models were used to assess the association between the E/A ratio and both all-cause mortality and incident cardiovascular disease (CVD). The mean follow-up period was 6.8 +/- 1.3 years. RESULTS: Of the 2211 participants in the study population (mean age 62 years, 65.1% women), 8.2% had an E/A ratio <0.7, 84.7% had an E/A 0.7-1.5, and 7.1% had an E/A >1.5. An E/A >1.5 was independently associated with all-cause mortality (hazard ratio [HR] 2.18, 95% confidence interval [CI] 1.20-4.03) in the multivariable model. An E/A <0.7 was associated with higher all-cause mortality (HR 1.79, 95% CI 1.17-2.73) and incident CVD (HR 1.91, 95% CI 1.29-2.83) compared with a normal E/A in the age and sex adjusted model but was not independently predictive in the multivariable model (P > .05). CONCLUSIONS: In a population-based cohort of middle-aged African Americans, an E/A >1.5 independently predicts all-cause mortality. An E/A >1.5 and an E/A <0.7 were both associated with incident CVD when adjusted for age and sex alone but were not independently predictive in the multivariable analysis.

Black or African American↗
PubMed2006

Austrian triad with sinus of Valsalva aneurysm and rupture.

An interesting case of a young patient presenting with Austrian's Triad: pneumococcal pneumonia, pneumococcal meningitis, and pneumococcal endocarditis. On echocardiogram the patient was noted to have a noncoronary sinus of Valsalva aneurysm and vegetations on the aortic cusps resulting in disruption of valvular integrity and severe aortic insufficiency. Color Doppler also revealed rupture of the aneurysm into the right atrium. The patient was taken to surgery where the noncoronary cusp was noted to be completely replaced with vegetative lesions. The aortic valve was replaced with a No. 21 Carpentier-Edwards bioprosthetic valve (Edwards Lifesciences, Irvine, CA), and the noncoronary sinus of Valsalva was repaired with concomitant closure of the fistula using glutaraldehyde autologous pericardium.

Adult↗
PubMed2005

Relation of aortic valve sclerosis to risk of coronary heart disease in African-Americans.

To assess the relation between aortic valve sclerosis (AVS) and subsequent occurrence of coronary heart disease (CHD) events, we analyzed echocardiographic data obtained from 2,279 middle-aged African-Americans enrolled in the Jackson Mississippi Atherosclerosis Risk in Communities study cohort who were free of known CHD at the time of the examination. Cox regression analyses demonstrated a hazard ratio of 3.8 for incident first myocardial infarction or fatal CHD after adjusted for multiple risk factors, including markers of inflammation. An amplification of CHD risk in the AVS subgroup with high levels of serum inflammatory markers (the highest quartile of fibrinogen and von Willebrand Factor levels) demonstrated greater than fivefold higher risk of CHD associated with AVS than risk in the lowest quartile.

Black or African American↗
PubMed2005

Left ventricular mass indexed to height and prevalent MRI cerebrovascular disease in an African American cohort: the Atherosclerotic Risk in Communities study.

BACKGROUND AND PURPOSE: Previous studies have demonstrated that echocardiographic left ventricular mass (LVM) is an independent risk factor for stroke in whites. Despite the greater burden of stroke, the echocardiographic predictors of stroke in African Americans remain poorly understood. METHODS: This investigation is a retrospective analysis of prospectively collected data from the Jackson, Miss (all African American), cohort of the Atherosclerotic Risk in the Communities study. Between 1993 and 1995, 2445 participants received an echocardiogram, and a random subset (n=778) received cerebral MRI evaluating presence of infarcts or white matter disease (WMD; >3 on a scale of 0 to 9). Compared with the entire Jackson cohort, the random subset was older, had a lower body mass index (BMI), and a higher systolic blood pressure (SBP). Logistic regression models examined the relations of LVM indexed by height (LVM/height) to MRI findings adjusted for age, gender, BMI, SBP, hypertensive medications, diabetes, total/high-density lipoprotein cholesterol, smoking status, and history of myocardial infarction. RESULTS: The 667 participants (63% women; 62+/-4 years of age) had a high prevalence of hypertension (68%), obesity (46%), echocardiographic left ventricular hypertrophy (49%), MRI stroke (n=133), and WMD (n=92). Adjusted LVM/height was significantly associated with prevalent MRI stroke (odds ratio [OR], 1.3; 95% CI, 1.1 to 1.7; P=0.02) and WMD (OR, 1.5; 95% CI, 1.1 to 1.9; P=0.006; OR expressed per 1 SD LVM/height, 45 g/m). CONCLUSIONS: In this randomized subset of a population-based cohort of African American adults, LVM/height was related to MRI evidence of prevalent cerebrovascular disease. The current study supports the hypothesis that LVM/height is an important risk factor for stroke in multiple ethnicities.

Black or African American↗
PubMed2003

Interatrial septal mobility predicts larger shunts across patent foramen ovales: an analysis with transmitral Doppler scanning.

BACKGROUND: The association of patent foramen ovale (PFO) with cryptogenic stroke is strongest in patients with larger shunts and patients with atrial septal aneurysms (ASAs). We postulated that the potency of ASA as a risk factor for stroke relates to the size of shunt across PFOs associated with mobile atrial septae. The purpose of this study was to investigate the relationship between atrial septal mobility and the degree of right-to-left shunting with a transthoracic transmitral Doppler scanning (TMD) contrast technique. METHODS: In 165 consecutive patients, transthoracic TMD recordings were made during a saline contrast study with the patient at rest and after a maneuver to increase right atrial pressure. Bubble transit corresponded to high intensity signals in the velocity envelope of the mitral inflow profile and was quantified by a bubble score. RESULTS: A PFO was diagnosed in 59 patients (36%). In 50 patients with PFO and adequate echocardiography images, the incidence of ASA was 52%. In this group, both total septal mobility and leftward deviation predicted the TMD bubble score at rest (Spearman rho 0.64, 0.64, respectively, P <.001) and after the maneuver (Spearman rho 0.74, 0.73, P <.001). In 28 patients with cerebral ischemic events, the maneuver bubble score was predictive for cryptogenic stroke (P =.02, odds ratio 7.58). There was a trend toward significance between total septal motion and cryptogenic stroke (P =.06). CONCLUSION: Atrial septal mobility predicts the degree of right-to-left shunts across PFOs. The role of excessive septal mobility in the etiology of stroke may therefore be caused by the greater opportunity for paradoxical embolism because of the size of the associated trans-PFO shunt.

Adult↗
PubMed2002

Pulse inversion harmonic imaging improves endocardial border visualization in two-dimensional images: comparison with harmonic imaging.

Pulse inversion harmonic imaging (PIHI) is a new modality that increases the detection of harmonic echoes and myocardial contrast by cancelling linearly transmitted signals. We tested whether PIHI improved the detection of endocardial borders in noncontrast 2-dimensional echocardiography. We compared PIHI with tissue harmonic imaging (THI), which decreases linearly transmitted signals using filters. Fundamental mode (FM) was compared with THI and PIHI in 50 consecutive patients. The global and segmental endocardial visualization scores measured with FM were significantly improved by using either THI or PIHI. The improvement of the global score compared with FM was slightly higher using PIHI than THI, because of an improved visualization of the base and the anterior wall with the PIHI technique compared with THI. The ratio of myocardial-to-cavity signal was similarly increased from FM with THI and PIHI. PIHI, a new modality for detection of myocardial contrast, can also be used for endocardial border visualization. It provides an improvement relative to THI for specific regions of the endocardium.

Echocardiography↗