Lawrence G Rudski

McGill University, Montréal, Quebec, Canada

Are you Lawrence G Rudski?

Claim your profile

Publications (20)68.14 Total impact

  • Lawrence G Rudski, Eduardo Bossone, David Langleben
    Chest 10/2014; 146(4):876-8. · 7.13 Impact Factor
  • Eduardo Bossone, Lawrence G Rudski, Ekkehard Grünig
    European Heart Journal – Cardiovascular Imaging 09/2014; · 3.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this article, we provide the rationale for the ELOPE (Evaluation of Long-term Outcomes after Pulmonary Embolism) Study, a prospective, observational, multicenter cohort study of patients with a newly diagnosed, first episode of pulmonary embolism (www.clinicaltrials.govNCT01174628) that aims to identify clinical, anatomic, physiologic and biomarker determinants of poor outcome after pulmonary embolism.Pulmonary embolism, the most serious form of venous thromboembolism (VTE), leads to the hospitalization or death of over 30 000 Canadians, 225 000 Americans and 300 000 Europeans each year, numbers that have risen over the past decade. Although numerous studies have evaluated optimal approaches to the diagnosis and treatment of pulmonary embolism, their focus has primarily been on short-term outcomes such as mortality and recurrent VTE in the days, weeks or months after pulmonary embolism diagnosis. However, it is increasingly recognized that pulmonary embolism may have long-lasting sequelae that impact on patients' health. The objective of this article was to review the available evidence on long-term clinical, functional, anatomic and physiologic outcomes after pulmonary embolism, and discuss avenues for research in this field, including the ELOPE Study. Residual pulmonary vascular abnormalities on follow-up imaging and echocardiogram are frequent in pulmonary embolism patients, but the clinical significance of these abnormalities is poorly understood. Whether initial and/or residual clot burden, recurrent pulmonary embolism, altered pulmonary artery or right ventricular hemodynamics or other prognostic factors such as biomarker levels contribute to long-term morbidity after pulmonary embolism is as yet unknown. The ELOPE Study will describe and identify the predictors of long-term outcomes after pulmonary embolism in the setting of a rigorous, multicenter cohort study in which long-term clinical, anatomic, physiologic and functional sequelae such as quality of life, return to work and loss of productivity after pulmonary embolism are systematically evaluated.
    Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 01/2014; · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In systemic sclerosis (SSc), impaired diffusing capacity for carbon monoxide (DLCO) can indicate interstitial lung disease (ILD), pulmonary hypertension (PH), and/or other disease manifestations, including anemia. We undertook this study to compare the various measures of DLCO in the setting of a complex disease like SSc. We analyzed the pulmonary function tests of a cohort of SSc subjects, as a whole and among subjects with isolated PH and ILD separately. Associations were assessed using Spearman correlation coefficients, Student’s t tests, and F tests by one-way ANOVA. P values <0.05 were considered statistically significant. This study included 225 subjects (mean age, 57 years; 88 % women; mean disease duration, 9.6 years; 32 % with diffuse disease, 44 % with ILD, and 17 % with PH). Mean percent predicted DLCO values were 75 % for DLCOsb and 83 % for DLCOrb. Adjustment for alveolar volume (VA) resulted in near normalization of both DLCOsb/VAsb (91 %) and DLCOrb/VArb (91 %). Subjects with ILD had significantly lower DLCOsb but not DLCOsb/VAsb, whereas those with PH had significantly lower DLCOsb and DLCOsb/VAsb. Among the various measures of DLCO, DLCOsb had the strongest and most consistent associations with clinical outcomes of interest. Adjusting for alveolar volume dampened the associations except with PH, with which DLCOsb/VAsb was more strongly associated than DLCOsb. Low DLCOsb is the most sensitive measure to detect abnormalities in gas exchange in SSc but reflects both parenchymal lung disease and pulmonary vascular disease. Low DLCOsb/VAsb is more specific for pulmonary vascular disease and should be the preferred measure of gas exchange in SSc.
    Clinical Rheumatology 06/2013; · 2.04 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Post-operative atrial fibrillation (AF) is a serious yet common complication after coronary artery bypass grafting surgery (CABG). Risk factors for post-operative AF have been identified, including echocardiographic parameters, and these are relied upon to implement preventative strategies that reduce the incidence of AF. There has yet to be a study examining the impact of echocardiographic right heart parameters for the prediction of post-operative AF. Thus, a panel of right heart parameters was measured in a cohort of patients undergoing isolated CABG, excluding those who did not have echocardiographic assessment within 30 days before surgery and those with any prior history of AF. The primary outcome was post-operative AF defined as any episode of AF requiring treatment during the index hospitalization. Post-operative AF occurred in 197 of 768 patients (25.6%); these were older and more likely to have hypertension and chronic kidney disease. After adjustment for clinical and echocardiographic variables, left atrial volume index ≥34 mL/m2 (OR 1.98, 95% CI 1.36 to 2.87), abnormal right ventricular myocardial performance index (RV-MPI) (OR 1.50 95% CI 1.01 to 2.24), and advancing age (OR 1.05, 95% CI 1.03 to 1.07) were found to be independent predictors of post-operative AF. In conclusion, RV-MPI is a novel predictor of post-operative AF in patients undergoing isolated CABG and appears to be additive to established risk factors such as age and left atrial volume.
    The American journal of cardiology 01/2013; · 3.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: What is the prevalence of occult left-heart disease in patients with scleroderma (SCL) and pulmonary hypertension (PH)? In patients with PH (mean pulmonary artery pressure mPAP≥25 ;mmHg), differentiation between pre/post capillary PH has been made according to pulmonary artery wedge pressure (PAWP) less/more than15 ;mmHg, respectively.Retrospective chart review of 107 SCL-patients. All patients with suspected PH had routine right/left heart catheterization with left ventricular end-diastolic pressure (LVEDP) measurement pre/post fluid challenge. We extracted demographic, hemodynamic and echocardiographic data. Patients were classified into one of four groups - hemodynamically normal (mPAP<25 ;mmHg), pulmonary venous hypertension PVH (mPAP≥25 ;mmHg, PAWP>15 ;mmHg), occult PVH (mPAP≥25 ;mmHg, PAWP≤15 ;mmHg, LVEDP>15 ;mmHg before/after fluid challenge) and Pulmonary Arterial Hypertension PAH (mPAP≥25 ;mmHg, PAWP≤15 ;mmHg and LVEDP≤15 ;mmHg before/after fluid challenge).Fifty-three of 107 patients had PH. Based on the PAWP-based definition 29/53 had PAH and 24/53 had PVH. After considering the resting and post-fluid-challenge LVEDP, 11 PAH patients were reclassified as occult PVH. The occult PVH group was hemodynamically, echocardiographically and demographically closer to the PVH group than the PAH group.PVH had high prevalence in our SCL-PH population. Distinguishing PAH from PVH with only PAWP may result in some PVH patients being misclassified as having PAH.
    European Respiratory Journal 12/2012; · 6.36 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Although echocardiography is commonly performed before coronary artery bypass surgery (CABG), there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. METHODS AND RESULTS: Patients undergoing isolated CABG at two hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the STS database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction as evidenced by restrictive filling (OR 2.96; 95% CI 1.59,5.49), RV dysfunction as evidenced by fractional area change <35% (OR 3.03; 95% CI 1.28,7.20) or myocardial performance index >0.40 (OR 1.89; 95% CI 1.13,3.15). These results were confirmed in the validation cohort of 187 patients. When added to the STS risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% CI 2.8%, 8.9%). In the Cox proportional hazards model, RV dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up. CONCLUSIONS: Preoperative echocardiography, in particular RV dysfunction and restrictive LV filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after CABG.
    Circulation 12/2012; · 15.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Recent registries describe a significant prevalence of pulmonary arterial hypertension (PAH) in the elderly, but little is known of their characteristics. We aimed to examine the features and prognostic factors of long-term survival in elderly (≥65 years) PAH patients. METHODS: Clinical, echocardiographic, angiographic, hemodynamic, treatments, and survival data were reviewed in consecutive patients over the course of 20 years. Elderly PAH patients (n = 47) were compared to younger PAH patients (n = 107). RESULTS: At presentation, elderly patients were more likely to have hypertension, diabetes, dyslipidemia, coronary disease, and PAH associated with scleroderma (42.6 vs. 24.3 %; p = 0.02) than younger patients. Prior to PAH therapy, elderly patients had better right ventricular myocardial performance index (RV-MPI; 0.48 ± 0.20 vs. 0.62 ± 0.23, p = 0.006) and lower mean pulmonary arterial pressure (PAP; 45.0 ± 11.1 vs. 49.2 ± 11.8 mmHg, p = 0.04). Elderly patients were treated less often with epoprostenol (8.5 vs. 29 %, p = 0.006) or trepostinil (8.5 vs. 23.4 %, p = 0.04). The 1, 3, and 5 year survival rates of elderly patients were estimated to be 76.4, 50.5, and 37.6 %, respectively. In comparison, younger patients had survival estimates of 92.2, 74.2 and 64.0 % (p = 0.002). Baseline right atrial pressure, mean PAP, cardiac index, and RV-MPI were associated with survival in elderly patients; however in these patients, survival was not affected by any PAH subgroup or age (per year) by itself. CONCLUSIONS: The diagnosis of PAH in elderly patients is associated with poorer survival which is in part explained by a greater vulnerability to the hemodynamic disturbances of PAH.
    Beiträge zur Klinik der Tuberkulose 10/2012; · 2.06 Impact Factor
  • Lawrence G Rudski, Jonathan Afilalo
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 07/2012; 25(7):714-7. · 2.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The incidence of pericardial effusion (PEF) during long-term follow-up among patients with pulmonary arterial hypertension (PAH) is unknown. We aimed to determine the incidence and prognostic significance of developing a new PEF among PAH patients. METHODS: Records of consecutive patients diagnosed with PAH between January 1990 and May 2010 were reviewed. Patients had systematically undergone right heart catheterization, transthoracic echocardiography, and coronary angiography during their initial assessment as well as routine echocardiograms during follow-up. Effusions were graded as small (echo-free space in diastole <10 mm), moderate (10-20 mm), or large (≥ 20 mm). RESULTS: The entire cohort consisted of 154 patients. The prevalence of identified PEF during initial assessment was 28.6%. The incidence of PEF among patients with no effusions who had additional echocardiographic studies during follow-up (n = 102) was 44.1%. Patients who developed PEF during follow-up had no differences with respect to baseline characteristics, associated aetiologies, hemodynamic parameters, and extent of coronary disease. Among these 102 patients, survival estimates were 94.9%, 75.0%, and 62.4% at 1, 3, and 5 years, respectively. Development of a PEF that was at least moderate-sized at its first appearance was a predictor of mortality in univariate (hazard ratio, 6.85; 95% confidence interval, 2.60-18.10) as well as multivariate analysis (hazard ratio, 3.95; 95% confidence interval, 1.26-12.40). CONCLUSIONS: PEF develops frequently in PAH patients. In patients with no PEF at baseline, the appearance of a new moderate-size or larger PEF is associated with increased mortality, whereas no significantly increased mortality was observed when a small PEF develops.
    The Canadian journal of cardiology 06/2012; · 3.12 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Guidelines for the provision of echocardiography in Canada were jointly developed and published by the Canadian Cardiovascular Society and the Canadian Society of Echocardiography in 2005. Since their publication, recognition of the importance of echocardiography to patient care has increased, along with the use of focused, point-of-care echocardiography by physicians of diverse clinical backgrounds and variable training. New guidelines for physician training and maintenance of competence in adult echocardiography were required to ensure that physicians providing either focused, point-of-care echocardiography or comprehensive echocardiography are appropriately trained and proficient in their use of echocardiography. In addition, revision of the guidelines was required to address technological advances and the desire to standardize echocardiography training across the country to facilitate the national recognition of a physician's expertise in echocardiography. This paper summarizes the new Guidelines for Physician Training and Maintenance of Competency in Adult Echocardiography, which are considerably more comprehensive than earlier guidelines and address many important issues not previously covered. These guidelines provide a blueprint for physician training despite different clinical backgrounds and help standardize physician training and training programs across the country. Adherence to the guidelines will ensure that physicians providing echocardiography have acquired sufficient expertise required for their specific practice. The document will also provide a framework for other national societies to standardize their training programs in echocardiography and will provide a benchmark by which competency in adult echocardiography may be measured.
    The Canadian journal of cardiology 07/2011; 27(6):862-4. · 3.12 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The occurrence and impact of coronary artery disease (CAD) among patients with pulmonary arterial hypertension (PAH) are unknown. We aimed to determine the prevalence, clinical correlates, and effect of CAD in patients with PAH. We reviewed the medical records of consecutive patients diagnosed with PAH at a university-based referral center for pulmonary vascular disease from January 1990 to May 2010. The patients systematically underwent right heart catheterization and coronary angiography as a part of their evaluation. The patients with PAH with CAD (defined as ≥50% stenosis in ≥1 major epicardial coronary artery) were compared to patients without CAD. Among the 162 patients with PAH, the prevalence of CAD was 28.4%. The presence of CAD was associated with older age (66.6 ± 11.5 vs 49.2 ± 14.0 years, p <0.001), systemic hypertension, and dyslipidemia. The patients with PAH and CAD had a lower mean pulmonary arterial pressure (44.6 ± 11.1 vs 49.2 ± 14.0 mm Hg; p = 0.02) than patients without CAD. During a median follow-up of 36 months, 73 patients died. The presence of CAD was a predictor of all-cause mortality on univariate analysis (hazard ratio 1.97, 95% confidence interval 1.21 to 3.20) but not on multivariate analysis, which identified older age (hazard ratio 1.03, 95% confidence interval 1.01 to 1.05) and right atrial pressure (hazard ratio 1.08, 95% confidence interval 1.03 to 1.14) as the only independent predictors. In conclusion, our study has demonstrated that CAD is common among patients with PAH. CAD prevalence increases with age, dyslipidemia, and hypertension, but we did not detect an independent prognostic effect of CAD on mortality.
    The American journal of cardiology 05/2011; 108(3):460-4. · 3.58 Impact Factor
  • Konstadina Darsaklis, Jonathan Afilalo, Lawrence G. Rudski
    [Show abstract] [Hide abstract]
    ABSTRACT: In the last decade, the role of the right ventricle (RV) has been increasingly recognized in a variety of conditions, contributing to the pathophysiology of disease and the prediction of outcomes. Recent echocardiography guidelines focused on the RV have been published by the American Society of Echocardiography to encourage a standardized approach in assessing RV size and function. In this article, we review the recently published echocardiography guidelines for assessing RV size and function, and their importance in clinical practice. We discuss advantages and disadvantages of currently available imaging techniques for evaluating the RV morphology, size, and systolic function. Basic methods such as TAPSE, tissue Doppler, RIMP, and fractional area change are discussed, as are more emerging techniques such as strain and strain rate. Additional insights are provided into upcoming uses of echocardiography in the areas or RV dyssynchrony and three-dimensional echocardiography. KeywordsEchocardiography–Right ventricle–Echocardiography - 3 dimensional–Strain imaging–Strain rate imaging–Resynchronization–Right heart
    Current Cardiovascular Imaging Reports 01/2011; 4(5):392-405.
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2011; 57(14).
  • Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 07/2010; 23(7):685-713; quiz 786-8. · 2.98 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 06/2009; 137(5):1278-80. · 3.41 Impact Factor
  • Dominique Joyal, Lawrence Rudski
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite recent meta-analyses showing either similar rates or only slightly increased rates of stent thrombosis in patients with a drug-eluting stent, clinicians remain concerned about the risk of late stent thrombosis in these patients. We are reporting on a "very-very" late stent thrombosis that occurred 43 months post-implantation. We believe this represents the most delayed reported thrombosis post-sirolimus-eluting stent implantation, which might not have been preventable using even the latest FDA recommendations.
    The Journal of invasive cardiology 10/2007; 19(9):E265-7. · 1.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical outcomes and echocardiographic parameters associated with aortic valve replacement (AVR) for bicuspid aortic valve are scarce. We conducted retrospective analysis of 208 adults with bicuspid aortic valve referred for transthoracic echocardiograms. The Kaplan-Meier survival free of death or need for cardiac surgery was 72% at 5 years. Cardiac surgery was performed in 19%, the majority (68%) for symptomatic aortic stenosis. Peak gradient 80 mm Hg or greater (hazard ratio 11.8, 95% confidence interval 3.7-37.8, P < .0001) and aortic valve area less than or equal to 0.75 cm(2) (hazard ratio 2.9, 95% confidence interval 1.0-8.5, P = .05) predicted the need for AVR. Patients with a large (54%) versus normal left ventricular outflow tract dimension underwent AVR for symptomatic aortic stenosis at a larger calculated aortic valve area (1.07 +/- 0.21 vs 0.75 +/- 0.18 cm(2), P < .0001) but at a similar peak gradient and velocity ratio (76 +/- 19 vs 76 +/- 22 mm Hg, P = not significant; 0.23 +/- 0.06 vs 0.26 +/- 0.12, P = not significant, respectively). Clinical events are common among patients with bicuspid aortic valve. Peak gradient 80 mm Hg or more and aortic valve area less than or equal to 0.75 cm(2) predicts the need for AVR. Gradients and velocity ratio better reflect the hemodynamic burden of aortic stenosis in patients with a large left ventricular outflow tract.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 08/2007; 20(8):998-1003. · 2.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Advances in surgery permit for earlier intervention with improved outcomes for patients with mitral regurgitation (MR). Many patients still appear to be referred to surgery late in their course. Consensus guidelines were compared with the surgical referral practices for MR among Canadian cardiologists. A self-administered questionnaire was mailed to all adult cardiologists in Canada. This included seven case scenarios, as well as direct questions designed to establish the influence of factors including atrial fibrillation, pulmonary hypertension, left ventricular (LV) dilation, experience of the cardiac surgeon, symptoms and ejection fraction (EF) on referral. There were 319 respondents; LVEF was rated as extremely important in 71.5% of patients and moderately important in 26% of patients. In asymptomatic patients, EF of 50% to 60% was correctly identified as a trigger for surgery by 57.2 % of cardiologists, while only 15.6% of cardiologists correctly referred New York Heart Association class II patients with normal LV function. The group complied in only 4.77 of the seven case scenarios. Compliance was inversely related to years in practice for asymptomatic patients with mild LV dysfunction, as well as in overall compliance. Referral practices were similar among clinicians, echocardiographers, interventional cardiologists and researchers, with no differences in geographic region or academic affiliation. Compliance with published guidelines for patients with MR and either New York Heart Association class II or mild LV dysfunction among Canadian cardiologists was poor. Compliance was somewhat better in more recent graduates, suggesting the need to institute programs geared at enhancing knowledge of published standards and introduce practical tools to aid in their implementation.
    The Canadian journal of cardiology 04/2007; 23(3):209-14. · 3.12 Impact Factor