Toral Patel

University of Virginia | UVa · Division of Cardiovascular Medicine

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used for refractory cardiogenic shock; however, it is associated with increased left ventricular afterload. Outcomes associated with the combination of a percutaneous left ventricular assist device (Impella) and VA-ECMO remains largely unknown. We retrospectively reviewed patients...

Atrioventricular conduction disturbances requiring implantation of permanent pacemaker (PPM) are a common complication following transcatheter aortic valve implantation (TAVI). Previous registry data are conflicting but suggestive of an increased risk in heart failure admissions in the post-TAVI PPM cohort. Given the expanding use of TAVI, the pres...

Objectives: Urgent transcatheter aortic valve replacement (TAVR) is associated with worse short-term outcomes compared with elective TAVR; however, little is known about long-term outcomes or the safety of the minimalist strategy in this setting. This study investigated the short-term and long-term outcomes of urgent TAVR compared with elective TA...

It is unknown whether gender influences the atherosclerotic plaque characteristics (APCs) of lesions of varying angiographic stenosis severity. This study evaluated the imaging data of 303 symptomatic patients from the derivation arm of the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial, all...

Open in new tabDownload slide

Introduction: Inflammation plays a key role in the development of atherosclerosis, yet targeted therapies are lacking. Previous trials have demonstrated that IL-1b is a potential target, albeit with adverse effects on immune suppression. IL-6 has emerged as another mediator of coronary artery disease. It clear that a strategy to identify a biomarke...

Background Peripheral artery disease (PAD) results in exercise-induced ischemia in leg muscles. ³¹ Phosphorus (P) magnetic resonance spectroscopy demonstrates prolonged phosphocreatine recovery time constant after exercise in PAD but has low signal to noise, low spatial resolution, and requires multinuclear hardware. Chemical exchange saturation tr...

Background The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. Objectives The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care...

Introduction: Creatine chemical exchange saturation transfer (CrCEST) is a novel MRI technique utilizing radiofrequency pulses to monitor creatine concentrations at high spatial resolution. The study utilized CrCEST kinetics to compare post-exercise creatine decay in peripheral arterial disease (PAD) patients to normal subjects and to validate agai...

Background: Structural remodeling in chronic systolic heart failure (HF) is associated with neurohormonal and hemodynamic perturbations among HF patients presenting with cardiogenic shock (CS) and HF. Our objective was to test the hypothesis was that atrial remodeling marked by an increased right atrial volume index (RAVI) to left atrial volume in...

Our understanding of sex differences in subclinical atherosclerosis and plaque composition and characteristics have greatly improved with the use of coronary computed tomography (CCTA) over the past years. CCTA has emerged as an important frontline diagnostic test for women, especially as we continue to understand the impact of non-obstructive athe...

Funding Acknowledgements Type of funding sources: None. Background Exercise testing is a well-known non-invasive assessment method for myocardial ischemia in patients with suspected coronary artery disease (CAD). Stress electrocardiography (ECG) alone is underutilized in this population despite guideline recommendations in part due to poor diagnos...

In Reply We appreciate the insightful comments by Gallen et al in response to our article.¹ We would like to thank JAMA Internal Medicine for the opportunity to respond to them.

Purpose of review This review is aimed at summarizing the recently published ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) and how its findings may impact cardiac imaging for stable ischemic heart disease (SIHD) moving forward. Recent findings The ISCHEMIA trial compared an initial in...

A patient in their 40s with a history of remote coronary artery bypass grafting, heart failure with reduced ejection fraction, and poorly controlled insulin-dependent diabetes was admitted to the cardiac intensive care unit with acute decompensated heart failure. The patient’s baseline electrocardiogram (ECG) demonstrated normal sinus rhythm, with...

Objectives: We share our center's experience with the use of transcatheter valvular therapies in the setting of failed bioprostheses. Background: As medicine continues to advance, the lifespan of individuals continues to increase, and current surgical valvular therapies begin to degrade prior to a person's end of life. It is important to evaluat...

Students and professionals alike are aware, to some degree, that confidence contributes to success in all facets of their lives. Confidence describes the beliefs that we hold about own potential to achieve an outcome. It contributes to the decisions that we make in our lives and careers and toward our ambitions. However, our levels of confidence ma...

Objectives: Data on next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge [VED] strategy) compared with the early-discharge (ED) strategy (2-3 days as a first-line option) after TAVR. Methods: We reviewed...

Objectives: To investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis (AS) and reduced ejection fraction (EF). Background: Patients with AS and concomitant low EF may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) v...

Objectives This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). Background There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. Methods Patient...

Cardiovascular disease (CVD) is the leading cause of mortality in India. Since community health workers (CHWs) have historically played a pivotal role in improving maternal and child health, it has been hypothesized that they have the potential to mitigate the impact of CVD in countries such as India. Project SEHAT is a cluster RCT to test the hypo...

Myocardial contusion and aortic injury are well-known cardiac complications of blunt chest trauma, but valvular injury is rare. Traumatic valve injuries most commonly involve the aortic valve, with isolated mitral valve injury being quite rare. We report a case of acute severe mitral regurgitation due to ruptured chordae tendineae requiring surgica...

Introduction: Patients who undergo transcatheter aortic valve replacement (TAVR) for severe, symptomatic aortic stenosis frequently have heart failure with reduced ejection fraction (HFrEF). TAVR is usually performed via the conventional approach (CA) in a hybrid OR under general anesthesia with transesophageal echocardiographic guidance. We utiliz...

Objectives: Meta-analyses based on peer-reviewed publications report a sensitivity of approximately 85% for rapid antigen streptococcus tests to diagnose group A streptococcal (GAS) pharyngitis. Because these meta-analyses excluded package inserts, we examined the test characteristics of rapid antigen streptococcal tests and molecular methods that...

The temporomandibular joint (TMJ) consists of bony articular surfaces of the mandibular fossa, the articular tubercle of the temporal bone, and the head of the mandible. The articular disc of the TMJ attaches to the capsule separating two synovial joint spaces lined by synovial membranes. The suprahyoid muscle group is also responsible for mandibul...

The autonomic nervous system (ANS), also known as the visceral motor system, is a complex network that is part of the peripheral nervous system that maintains internal physiologic homeostasis. The ANS is divided into the parasympathetic (PNS) and sympathetic (SNS) nervous systems. Sympathetic nerve fibers from the head to the sacral region stem fro...

Age-associated changes to aortic anatomy and physiology have an effect on hemodynamics and play a large role in the genesis of cardiovascular pathologies including atherosclerosis, congestive heart failure, and aortic aneurysm. Despite their recognized role in hemodynamics, the complete mechanism for aortic aging is still not clear and their full e...

Benjamin Hobson was a British missionary and physician who lived in China for twenty years. He founded multiple hospitals in Southern China and used his knowledge of Western medicine to educate Chinese doctors. He wrote several medical textbooks in Chinese of which the first was the A New Theory of the Body (1851). The illustrations from his book w...

Dyskeratosis congenita (DC) is an inherited multisystem disorder of premature aging, cancer predisposition, and bone marrow failure caused by selective exhaustion of highly proliferative cell pools. DC patients also have a poor tolerance to chemo/radiotherapy and bone marrow transplantation. Although critically shortened telomeres and defective tel...

A decline in learning and memory is a feature of the normal aging process and associated with neurodegenerative diseases such as dementia and Alzheimer's disease. Moreover, certain forms of dementia and memory loss are inevitable due to the normal aging process. The unavoidable effect of age on memory is an ongoing study, as the findings assist in...

2359 Introduction Dyskeratosis congenita (DC) is an inherited multisystem disorder consisting of premature aging, cancer predisposition, bone marrow failure and the characteristic triad of mucosal leukoplakia, skin dyspigmentation and nail dystrophy. Symptomology associated with DC arises as a consequence of mutations within genes associated with...

Coronary Artery Disease (CAD) is the leading cause of deaths worldwide, including the United States. Atherosclerosis remains the primary cause of CAD, and is a leading target for drug treatments. Despite advances in treatments, many questions remain unanswered pertaining to the mechanisms of the treatments on inflammation and oxidative stress. We h...