2023
Detection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images
Sangha V, Nargesi A, Dhingra L, Khunte A, Mortazavi B, Ribeiro A, Banina E, Adeola O, Garg N, Brandt C, Miller E, Ribeiro A, Velazquez E, Giatti L, Barreto S, Foppa M, Yuan N, Ouyang D, Krumholz H, Khera R. Detection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images. Circulation 2023, 148: 765-777. PMID: 37489538, PMCID: PMC10982757, DOI: 10.1161/circulationaha.122.062646.Peer-Reviewed Original ResearchMeSH KeywordsAdultElectrocardiographyHumansLongitudinal StudiesProspective StudiesVentricular Dysfunction, LeftVentricular Function, LeftConceptsLV systolic dysfunctionYale-New Haven HospitalVentricular systolic dysfunctionSystolic dysfunctionLV ejection fractionBrazilian Longitudinal StudyNew Haven HospitalEjection fractionCardiology clinicRegional hospitalLeft ventricular systolic dysfunctionCedars-Sinai Medical CenterAdult Health (ELSA-Brasil) cohort
2022
Automated multilabel diagnosis on electrocardiographic images and signals
Sangha V, Mortazavi BJ, Haimovich AD, Ribeiro AH, Brandt CA, Jacoby DL, Schulz WL, Krumholz HM, Ribeiro ALP, Khera R. Automated multilabel diagnosis on electrocardiographic images and signals. Nature Communications 2022, 13: 1583. PMID: 35332137, PMCID: PMC8948243, DOI: 10.1038/s41467-022-29153-3.Peer-Reviewed Original ResearchConceptsConvolutional neural networkArtificial intelligenceApplication of AISignal-based dataSignal-based modelElectrocardiographic imagesECG imagesGrad-CAMImage-based modelsNeural networkDiagnosis modelECG signalsImagesClinical labelsValidation setLabelsExternal validation setMultilabelIntelligenceNetworkApplicationsModelBroad useSetBroader setting
2021
Impact of ST‐Segment–Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non–ST‐Segment–Elevation Myocardial Infarction
Montoy JCC, Shen Y, Brindis RG, Krumholz HM, Hsia RY. Impact of ST‐Segment–Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non–ST‐Segment–Elevation Myocardial Infarction. Journal Of The American Heart Association 2021, 10: e016932. PMID: 33470136, PMCID: PMC7955417, DOI: 10.1161/jaha.120.016932.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCaliforniaCoronary AngiographyEarly DiagnosisElectrocardiographyFemaleFollow-Up StudiesHospitalizationHumansMaleMiddle AgedNon-ST Elevated Myocardial InfarctionPercutaneous Coronary InterventionPrognosisProgram EvaluationRegistriesRetrospective StudiesRisk FactorsST Elevation Myocardial InfarctionSurvival RateTreatment OutcomeConceptsOutcomes of patientsEarly angiographyMyocardial infarctionST segmentST-segment elevation myocardial infarctionSegment elevation myocardial infarctionProportion of patientsElevation myocardial infarctionRisk of deathRisk of mortalityRegionalization programIndex admissionEmergency departmentRegionalized careNonfederal hospitalsMAIN OUTCOMETimely carePatientsAngiographyOverall populationNSTEMIInfarctionStudy periodMortalityCare
2019
Application of the VIRGO taxonomy to differentiate acute myocardial infarction in young women
Sciria CT, Dreyer RP, D'Onofrio G, Safdar B, Krumholz HM, Spatz ES. Application of the VIRGO taxonomy to differentiate acute myocardial infarction in young women. International Journal Of Cardiology 2019, 288: 5-11. PMID: 31031078, DOI: 10.1016/j.ijcard.2019.03.054.Peer-Reviewed Original ResearchConceptsCoronary artery diseaseCardiac catheterizationYoung womenNon-obstructive coronary artery diseaseSingle-center retrospective chart reviewYoung AMI Patients (VIRGO) studyObstructive coronary artery diseaseRetrospective chart reviewAcute myocardial infarctionProportion of womenUniversal definitionIndex admissionChart reviewArtery diseaseConsecutive womenMyocardial infarctionTreatment strategiesCatheterizationMore young womenType 2Type 1Class IType 4BWomenPatient studies
2018
Screening ECGs in low-risk patients are associated with increased risk of downstream cardiac testing
Mahajan S, Krumholz HM. Screening ECGs in low-risk patients are associated with increased risk of downstream cardiac testing. BMJ Evidence-Based Medicine 2018, 23: 150. PMID: 29674521, DOI: 10.1136/bmjebm-2018-110943.Peer-Reviewed Original ResearchSex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics
Gupta A, Barrabes JA, Strait K, Bueno H, Porta‐Sánchez A, Acosta‐Vélez J, Lidón R, Spatz E, Geda M, Dreyer RP, Lorenze N, Lichtman J, D'Onofrio G, Krumholz HM. Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics. Journal Of The American Heart Association 2018, 7: e007021. PMID: 29514807, PMCID: PMC5907538, DOI: 10.1161/jaha.117.007021.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge of OnsetElectrocardiographyFemaleHealthcare DisparitiesHumansMaleMiddle AgedMyocardial ReperfusionPredictive Value of TestsProspective StudiesRisk AssessmentRisk FactorsSex FactorsSpainST Elevation Myocardial InfarctionTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesYoung AdultConceptsST-segment elevation myocardial infarctionElectrocardiographic characteristicsMyocardial infarctionReperfusion delayYounger patientsVentricular hypertrophyST elevationPrehospital ECGLateral leadsMultivariable logistic regression modelTimeliness of reperfusionVoltage criteriaElevation myocardial infarctionLeft ventricular hypertrophyAcute myocardial infarctionYears of ageLogistic regression modelsSex differencesClinical characteristicsCohort studyElectrocardiographic correlatesMultivariable analysisFemale sexSpanish hospitalsReperfusion guidelines
2017
Comparison of Electrocardiographic Characteristics in Men Versus Women ≤ 55 Years With Acute Myocardial Infarction (a Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients Substudy)
Barrabés JA, Gupta A, Porta-Sánchez A, Strait KM, Acosta-Vélez JG, D'Onofrio G, Lidón RM, Geda M, Dreyer RP, Lorenze NP, Lichtman JH, Spertus JA, Bueno H, Krumholz HM. Comparison of Electrocardiographic Characteristics in Men Versus Women ≤ 55 Years With Acute Myocardial Infarction (a Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients Substudy). The American Journal Of Cardiology 2017, 120: 1727-1733. PMID: 28865896, DOI: 10.1016/j.amjcard.2017.07.106.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionST-segment depressionElectrocardiographic presentationMyocardial infarctionQ wavesAnterior ST segment depressionST-segment elevation myocardial infarction diagnosisOutcome of AMIYoung AMI patientsMen Versus WomenST-segment elevationLonger QTc intervalsIntraventricular conduction disturbancesCentral core labNegative T wavesAbnormal Q wavesGender-related differencesBaseline characteristicsContemporary registryAnterior leadsMyocardial infarction diagnosisYounger patientsQTc intervalAMI patientsWorse prognosis
2015
2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O’Gara P, Kushner FG, Ascheim DD, Brindis RG, Casey DE, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Journal Of The American College Of Cardiology 2015, 67: 1235-1250. PMID: 26498666, DOI: 10.1016/j.jacc.2015.10.005.Peer-Reviewed Original Research2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O'Gara PT, Kushner FG, Ascheim DD, Brindis RG, Casey DE, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction. Circulation 2015, 133: 1135-1147. PMID: 26490017, DOI: 10.1161/cir.0000000000000336.Peer-Reviewed Original ResearchSex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction
D'Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, Spertus JA, Krumholz HM. Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction. Circulation 2015, 131: 1324-1332. PMID: 25792558, PMCID: PMC4652789, DOI: 10.1161/circulationaha.114.012293.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionMyocardial infarctionReperfusion therapyAcute ST-segment elevation myocardial infarctionProspective observational cohort studyYoung AMI Patients (VIRGO) studyTime guidelinesYoung womenObservational cohort studyProportion of patientsElevation myocardial infarctionPercutaneous coronary interventionYears of ageSex differencesPatients 18Reperfusion strategyCohort studyCoronary interventionFibrinolytic therapyNeedle timeYounger patientsReperfusion delayRatio of womenReperfusion guidelinesSex disparities
2014
STEMI Care in LMIC Obstacles and Opportunities
Murugiah K, Nuti SV, Krumholz HM. STEMI Care in LMIC Obstacles and Opportunities. Global Heart 2014, 9: 429-430. PMID: 25592797, PMCID: PMC5459383, DOI: 10.1016/j.gheart.2014.08.010.Commentaries, Editorials and Letters
2012
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
O’Gara P, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso JE, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation 2012, 127: 529-555. PMID: 23247303, DOI: 10.1161/cir.0b013e3182742c84.Peer-Reviewed Original ResearchAmerican Heart AssociationCardiologyDiagnostic Techniques, CardiovascularDisease ManagementElectrocardiographyEmergency Medical ServicesEvidence-Based MedicineHumansMedication Therapy ManagementMyocardial InfarctionMyocardial ReperfusionPatient SelectionPercutaneous Coronary InterventionRisk AssessmentThrombolytic TherapyUnited States2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal Of The American College Of Cardiology 2012, 61: 485-510. PMID: 23256913, DOI: 10.1016/j.jacc.2012.11.018.Peer-Reviewed Original ResearchAmerican Heart AssociationCardiologyClinical ProtocolsDiagnostic Techniques, CardiovascularDisease ManagementElectrocardiographyEmergency Medical ServicesEvidence-Based MedicineHumansMedication Therapy ManagementMyocardial InfarctionMyocardial ReperfusionPatient SelectionPercutaneous Coronary InterventionRisk AssessmentThrombolytic TherapyUnited States2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal Of The American College Of Cardiology 2012, 61: e78-e140. PMID: 23256914, DOI: 10.1016/j.jacc.2012.11.019.Peer-Reviewed Original ResearchAmerican Heart AssociationCardiologyClinical ProtocolsCoronary Artery BypassDiagnostic Techniques, CardiovascularDisease ManagementElectrocardiographyEmergency Medical ServicesEvidence-Based MedicineHumansMedication Therapy ManagementMyocardial InfarctionMyocardial ReperfusionPatient SelectionPercutaneous Coronary InterventionRisk AssessmentThrombolytic TherapyUnited States2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation 2012, 127: e362-e425. PMID: 23247304, DOI: 10.1161/cir.0b013e3182742cf6.Peer-Reviewed Original ResearchAmerican Heart AssociationCardiologyClinical ProtocolsDiagnostic Techniques, CardiovascularDisease ManagementElectrocardiographyEmergency Medical ServicesEvidence-Based MedicineHumansMedication Therapy ManagementMyocardial InfarctionMyocardial ReperfusionPatient SelectionPercutaneous Coronary InterventionRisk AssessmentThrombolytic TherapyUnited States2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Circulation 2012, 126: 3097-3137. PMID: 23166210, DOI: 10.1161/cir.0b013e3182776f83.Peer-Reviewed Original Research2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal Of The American College Of Cardiology 2012, 60: e44-e164. PMID: 23182125, DOI: 10.1016/j.jacc.2012.07.013.Peer-Reviewed Original ResearchMeSH KeywordsAcute Coronary SyndromeAdrenergic beta-AntagonistsAlcohol DrinkingAngina PectorisBody WeightCholesterol, LDLClopidogrelComorbidityCost of IllnessDepressionDiabetes ComplicationsDisease ManagementElectrocardiographyExerciseExercise TestGlycated HemoglobinHealth BehaviorHumansHypertensionLife StyleMyocardial InfarctionMyocardial IschemiaMyocardial RevascularizationPhysical ExaminationPlatelet Aggregation InhibitorsPractice Guidelines as TopicQuality of LifeRisk AssessmentRisk FactorsRisk Reduction BehaviorSmoking CessationTiclopidineConceptsAmerican CollegeAmerican Heart Association Task ForcePreventive Cardiovascular Nurses AssociationCardiology Foundation/American Heart Association Task ForceManagement of patientsThoracic surgeryPractice guidelinesCardiovascular AngiographyThoracic surgeonsSTS guidelinesA ReportNurses AssociationAmerican AssociationTask ForceAssociationGuidelinesPatientsSurgeryAngiographyPhysiciansDiagnosisSurgeonsPhysical function and independence 1 year after myocardial infarction: Observations from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry
Dodson JA, Arnold SV, Reid KJ, Gill TM, Rich MW, Masoudi FA, Spertus JA, Krumholz HM, Alexander KP. Physical function and independence 1 year after myocardial infarction: Observations from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry. American Heart Journal 2012, 163: 790-796. PMID: 22607856, PMCID: PMC3359897, DOI: 10.1016/j.ahj.2012.02.024.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAge FactorsAgedAngioplasty, Balloon, CoronaryAttitude to HealthCardiac CatheterizationCoronary AngiographyDepressionElectrocardiographyFemaleFollow-Up StudiesHealth SurveysHumansIncidenceIndependent LivingMaleMiddle AgedMultivariate AnalysisMyocardial InfarctionPhysical FitnessPoisson DistributionPredictive Value of TestsQuality of LifeRegistriesRisk AssessmentSickness Impact ProfileSurveys and QuestionnairesSurvivorsTime FactorsTranslational Research, BiomedicalConceptsAcute myocardial infarctionPhysical function declineFunction declinePhysical functionMyocardial infarctionHealth statusEuroQol-5DUninsured statusTime of AMIShort Form-12 Physical Component ScoreIndependence lossEnd-stage renal diseasePost-acute myocardial infarctionCardiac rehabilitation referralPhysical component scorePatients' health statusQuality of lifePoisson regression modelsTRIUMPH registryRehabilitation referralRenal diseaseNonwhite raceFemale sexRisk factorsUnmarried status
2010
Delay From Symptom Onset to Hospital Presentation for Patients With Non–ST-Segment Elevation Myocardial Infarction
Ting HH, Chen AY, Roe MT, Chan PS, Spertus JA, Nallamothu BK, Sullivan MD, DeLong ER, Bradley EH, Krumholz HM, Peterson ED. Delay From Symptom Onset to Hospital Presentation for Patients With Non–ST-Segment Elevation Myocardial Infarction. JAMA Internal Medicine 2010, 170: 1834-1841. PMID: 21059977, DOI: 10.1001/archinternmed.2010.385.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionElevation myocardial infarctionHospital presentationSymptom onsetHospital mortalityMultivariable adjustmentMyocardial infarctionUnstable Angina Patients Suppress Adverse OutcomesCan Rapid Risk StratificationSegment elevation myocardial infarctionNational quality improvement initiativeRapid Risk StratificationQuality improvement initiativesMedian delay timeSecular trendsNon–STCurrent smokingRisk stratificationNonwhite raceAdverse outcomesFemale sexOdds ratioEarly presentationAmerican CollegePatientsOpportunities to Improve Care for Patients With ST-Segment Elevation Myocardial Infarction: Focusing on How to Deliver the Care
Krumholz H. Opportunities to Improve Care for Patients With ST-Segment Elevation Myocardial Infarction: Focusing on How to Deliver the Care. Revista Española De Cardiología 2010, 63: 509-512. PMID: 20450842, DOI: 10.1016/s1885-5857(10)70110-9.Peer-Reviewed Original Research