Brian P Griffin

Cleveland Clinic, Cleveland, Ohio, United States

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Publications (141)792.02 Total impact

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    ABSTRACT: Data are lacking on the effect of renin-angiotensin system (RAS) blockade therapy with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers after surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS).
    Annals of internal medicine 11/2014; 161(10):699-710. · 13.98 Impact Factor
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    ABSTRACT: Cardiac allograft vasculopathy (CAV), an important cause of graft failure and mortality after the third year of orthotopic heart transplant (OHT), is commonly evaluated using dobutamine stress echocardiography (DSE). We sought to study a) the incidence of positive results and diagnostic accuracy of DSE and b) the predictors of adverse outcomes in OHT patients.Methods We studied 497 consecutive patients (63±10 years, 78% men) with OHT who had undergone DSE as part of routine surveillance at our center between 1998 and 2013. Every DSE and coronary angiogram performed during follow-up was reviewed. CAV was re-graded according to 2010 recommendations of the International Society for Heart and Lung Transplantation. Composite events (death, coronary revascularization, myocardial infarction and re-transplantation) were recorded.ResultsThere were 1,243 DSE studies performed during a median of 8.7 (6.2-11.9) years following transplantation. Only 22 studies (1.8%) were positive, 978 (78.7%) were negative and 243 (19.5%) were non-diagnostic (submaximal heart rate response) for ischemia. Among 497 patients, only 20 (4%) had atleast one positive DSE study. There were 310 diagnostic DSE’s with coronary angiograms performed within 1 year of each other. In this subgroup, the sensitivity, specificity, positive and negative predictive value of DSE were as follows: to detect any CAV (7%, 98%, 82% and 41%, respectively) and to detect CAV grade 2-3 (28%, 98%, 71% and 89%, respectively). There were no deaths during DSE. In 5.6±3.6 years after DSE, there were 201 (40%) events. Degree of CAV (and not DSE-based ischemia, p=0.3) independently predicted outcomes (p<0.001).Conclusions In OHT patients undergoing surveillance DSE, the incidence of a positive result is very low. DSE is insufficiently sensitive for detection of early CAV. Degree of CAV and not DSE-based ischemia independently predicted outcomes.
    The Journal of Heart and Lung Transplantation. 11/2014;
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    ABSTRACT: We investigated the effects of lung transplantation on right ventricular (RV) function as well as the prognostic value of pre- and post-transplantation RV function.Background Although lung transplantation success has improved over recent decades, outcomes remain a challenge. Identifying predictors of mortality in lung transplant recipients may lead to improved long-term outcomes after lung transplantation.Methods Eighty-nine (age 60 ± 6 years, 58 men) consecutive patients who underwent single or double lung transplantation and had pre- and post-transplantation echocardiograms between July 2001 and August 2012 were evaluated. Echocardiographic measurements were performed before and after lung transplantation. Left ventricular (LV) and RV longitudinal strains were analyzed using velocity vector imaging. Cox proportional prognostic hazard models predicting all-cause death were built.ResultsThere were 46 all-cause (52%) and 17 cardiac (19%) deaths during 43 ± 33 months of follow-up. After lung transplantation, echocardiography showed improved systolic pulmonary artery pressure (SPAP) (50 ± 19 mm Hg to 40 ± 13 mm Hg) and RV strain (−17 ± 5% to −18 ± 4%). No pre-transplantation RV parameter predicted all-cause mortality. After adjustment for age, sex, surgery type, and etiology of lung disease in a Cox proportional hazards model, both post-transplantation RV strain (hazard ratio: 1.13, 95% confidence interval: 1.04 to 1.23, p = 0.005), and post-transplantation SPAP (hazard ratio: 1.03, 95% confidence interval: 1.01 to 1.05, p = 0.011) were independent predictors of all-cause mortality. When post-transplantation RV strain and post-transplantation SPAP were added the clinical predictive model based on age, sex, surgery type, and etiology, the C-statistic improves from 0.60 to 0.80 (p = 0.002).Conclusions Alterations of RV function and pulmonary artery pressure normalize, and post-transplantation RV function may provide prognostic data in patients after lung transplantation. Our study is based on a highly and retrospectively selected group. We believe that larger prospective studies are warranted to confirm this result.
    JACC: Cardiovascular Imaging. 11/2014;
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    ABSTRACT: -We sought to assess the utility of left ventricular global longitudinal strain (LV-GLS) in predicting mortality in moderate to severe and paradoxical severe aortic stenosis (AS) patients with preserved ejection fraction (EF).
    Circulation Cardiovascular Imaging 10/2014; · 5.80 Impact Factor
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    ABSTRACT: Longitudinal strain of right ventricle (RV) can be used to determine RV systolic function. This study compared RV longitudinal strain values of two different speckle tracking software technologies, velocity vector imaging (VVI) and two-dimensional speckle tracking echocardiography (2DSTE), and longitudinal strain by cardiac magnetic resonance (CMR).
    Echocardiography 09/2014; · 1.26 Impact Factor
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    ABSTRACT: In primary mitral regurgitation (MR), exercise echocardiography aids in symptom evaluation and timing of mitral valve (MV) surgery. In patients with grade ≥3 primary MR undergoing exercise echocardiography followed by MV surgery, we sought to assess predictors of outcomes and whether delaying MV surgery adversely affects outcomes.
    Journal of the American Heart Association. 09/2014; 3(5).
  • Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 09/2014; 27(9):911-39. · 2.98 Impact Factor
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    ABSTRACT: Ischemic mitral regurgitation (IMR) is associated with poor outcomes in patients with coronary artery disease. The impact of percutaneous coronary intervention (PCI) on patients with IMR is not well elucidated. We sought to determine the outcomes of patients with severe IMR who underwent PCI. Patients with severe (≥3+) IMR who underwent PCI from 1998 to 2010 were identified. Improvement in IMR was defined as reduction in severity from ≥3+ to ≤2+ without any other invasive intervention beyond PCI. Outcomes were compared between patients with and without improvement in IMR after PCI. One hundred thirty-seven patients with severe IMR were included in our study. After PCI, 50 patients (36.5%) had improvement in IMR with PCI alone and 24 patients (18.5%) required another intervention. Left atrial size was a significant predictor of improvement in IMR (odds ratio 0.39, 95% confidence interval 0.2 to 0.8). Left ventricular size decreased (systolic diameter 3.9 ± 0.3 vs 4.6 ± 0.2 cm, p = 0.0008 and diastolic diameter 5.2 ± 0.2 vs 5.7 ± 0.2 cm, p = 0.002) and ejection fraction increased (39.1 ± 4.0% vs 33.1 ± 1.9%, p = 0.002) significantly after PCI in the patients with improvement in IMR compared with patients without improvement. Patients with improvement in IMR had numerically better survival; however, it was not statistically significant (p log-rank = 0.2). In conclusion, 1/3 of the patients with IMR had improvement in severity of IMR with PCI alone. Improvement in IMR was associated with left ventricular reverse remodeling. Left atrial size was an important predictor of improvement in IMR after PCI.
    The American Journal of Cardiology 07/2014; S0002-9149(14)01440-4. · 3.21 Impact Factor
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    ABSTRACT: The distinction of hypertrophic cardiomyopathy (HCM) or cardiac amyloidosis (CA) from hypertensive heart disease may be difficult. The aim of this study was to determine the impact of parametric (polar) maps of regional longitudinal strain on identification of the etiology of mild to moderate left ventricular hypertrophy (LVH).
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 05/2014; · 2.98 Impact Factor
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    ABSTRACT: Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1% to 2% of the population. Eventually, 20% develop clinically important valvar regurgitation requiring surgical intervention. Aortic valve repair avoids anticoagulation and prosthetic valve-related complications. This study evaluated long-term durability of BAV repair. From 1985 to 2011, 728 patients, mean age 42 ± 12 years, underwent BAV repair at Cleveland Clinic. Mean follow-up was 9.0 ± 6.2 years (median, 8.3). Factors associated with repair durability (expressed as aortic valve reoperations and echocardiographically estimated gradients and regurgitation) and survival were identified. Hospital mortality was 0.41% (n = 3), and stroke occurred in 0.27% (n = 2). Freedom from aortic valve reoperation at 10 years was 78%. Risk of reoperation was highest immediately after operation and fell rapidly to approximately 2.6%/year up to 15 years. Primary reasons for reoperation were cusp prolapse (38%), aortic stenosis or regurgitation (17%), and aortic regurgitation from root aneurysm (15%). Aortic valve gradients showed an early initial peak, rapidly declined, then rose steadily, accompanied by an increase in left ventricular mass. Survival was 94% at 10 years. A risk factor for early death was greater preoperative mitral valve regurgitation, and for late death, older age at operation, more severe symptoms, and poorer left ventricular function. BAV repair is safe and durable with low mortality, low prevalence of reoperation, and good long-term survival. Cusp prolapse from technical errors and natural progression of disease are the most common causes for reoperation, but progressive natural increase in valve gradient accounts for a substantial proportion as well.
    The Annals of thoracic surgery 03/2014; · 3.45 Impact Factor
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    ABSTRACT: Thoracic radiation leads to radiation-associated cardiac disease (RACD), associated with substantial cardiac morbidity and mortality, often requiring complex cardiothoracic surgery. In patients with RACD, along with valvular lesions, the aorto-mitral curtain (AMC, junction between base of anterior mitral leaflet and aortic root) thickness is increased on transthoracic echocardiography. We sought to identify clinical and transthoracic echocardiography predictors of long-term mortality in patients with RACD. We studied 173 patients with RACD (75% women, 63 ± 14 years, 53% with breast cancer, 27% with Hodgkin lymphoma; mean time from radiation, 18 ± 12 years), who underwent cardiothoracic surgery (26% redo) between 2000 and 2003. Clinical, transthoracic echocardiography (along with AMC), and surgical variables were recorded. Preoperative EuroSCORE and all-cause mortality were recorded. Mean left ventricular ejection fraction, right systolic ventricular pressure, and AMC thickness were 0.49 ± 0.13, 41 ± 15 mm Hg, and 0.54 ± 0.2 cm, respectively. Fifty-one percent of patients had II+ mitral regurgitation or greater, 29% patients had II+ aortic regurgitation or greater, 23% patients had severe aortic stenosis, and 34% patients had II+ tricuspid regurgitation or greater. In 7.6 ± 3 years of follow-up, there were 95 (55%) deaths, with a 30-day mortality rate of only 7 (4%). Absence of β-blockers (hazard ratio, 0.49; 95% confidence interval, 0.31 to 0.79), aspirin (hazard ratio, 0.53; 95% confidence interval, 0.33 to 0.84), higher EuroSCORE (hazard ratio, 1.11; 95% confidence interval, 1.02 to 1.21), and greater AMC thickness (hazard ratio, 5.75; 95% confidence interval, 1.57 to 21.03; all p < 0.01) independently predicted mortality. Aorto-mitral curtain thickness of at least 0.6 cm was associated with significantly increased mortality. Patients with RACD undergoing cardiothoracic surgery have high long-term mortality, which is independently predicted by AMC thickness, a higher preoperative risk score, and lack of cardioprotective medications.
    The Annals of thoracic surgery 02/2014; · 3.45 Impact Factor
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    ABSTRACT: -The decision-making role of exercise echocardiography in the surgical timing for aortic regurgitation (AR) remains a matter of debate due to limited data on its link with outcome. The aim of this study was to assess the role of echocardiographic measurements at rest and during exercise as predictors of valve surgery in asymptomatic aortic regurgitation. -Comprehensive resting and exercise echocardiography was performed in 159 consecutive patients (50±15y; 80% male) with isolated moderately severe to severe AR and preserved left ventricular (LV) function (LV ejection fraction >50%, LV end-diastolic dimension ≤70mm, LV end-systolic dimension ≤50mm or ≤25mm/m(2)) in whom initial management was expectant. Echocardiographic measurements were performed at rest and during exercise. LV and right ventricular (RV) longitudinal strain was analyzed at rest using velocity vector imaging. Valve surgery was performed in 50 patients (31%) over 30±21 months. After adjustment for age and gender in a multivariable Cox proportional hazards model, exercise tricuspid annular plane systolic excursion (TAPSE) (HR=0.48 p=0.001) was associated with valve surgery-free, independent of resting LV strain (HR=1.63, p=0.005), exercise LV end-diastolic volume (HR=1.38, p=0.048) and resting RV strain (HR=1.69, p=0.002). In sequential Cox models, a model based on clinical data (chi-square, 20.4) was improved by resting LV strain (chi-square, 30.1, p=0.001), resting RV strain (chi-square, 49.7, p<0.001) and further increased by exercise TAPSE (chi-square, 64.4, p<0.001). -In asymptomatic AR, resting LV strain, resting RV strain and exercise TAPSE were independently associated with the need for earlier aortic surgery.
    Circulation Cardiovascular Imaging 02/2014; · 5.80 Impact Factor
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    ABSTRACT: Significant myxomatous mitral regurgitation (MR) leads to progressive left ventricular (LV) decline, resulting in congestive heart failure (CHF) and death. Such patients benefit from mitral valve (MV) surgery. Exercise echocardiography (ExEc) aids in risk stratification and helps decide surgical timing. We sought to assess predictors of outcomes in such patients undergoing ExEc. This is an observational study of 884 consecutive patients (58±14 years, 67% men) with ≥III+ myxomatous MR who underwent ExEc between 1/2000 and 12/2011 (excluding functional MR, prior valvular surgery, hypertrophic cardiomyopathy, rheumatic valvular disease or >mild mitral stenosis). Clinical and echocardiographic data [MR, LV ejection fraction, LV dimensions, right ventricular systolic pressure (RVSP)] & exercise variables [metabolic equivalents (METS), heart rate recovery (HRR) at 1(st) minute post-exercise] were recorded. Composite events of death, myocardial infarction, stroke and progression to CHF were recorded. Mean LV ejection fraction, indexed LV end-systolic dimension, rest RVSP, peak-stress RVSP, METs achieved and HRR were 58±5%, 1.6±0.4 mm/m2, 31±12 mm Hg, 46±17 mm Hg, 9.6±3 and 33±14 beats, respectively. During 6.4±4 years of follow-up, there were 87 events. On stepwise multivariable Cox analysis, %age-gender predicted METs (Hazard ratio or HR 0.99 [0.98-0.99], p=0.005), HRR (HR 0.29 [0.17-0.50], p<0.001), resting RVSP (HR 1.03 [1.004-1.05], p=0.02), atrial fibrillation (HR 1.91 [1.07-3.41], p=0.03) and LV ejection fraction (HR 0.96 [0.92-0.99], p=0.04) predicted outcomes. In patients with ≥III+ myxomatous MR undergoing ExEc, lower %age-gender predicted METS, lower HRR, atrial fibrillation, lower LV ejection fraction and high resting RVSP predicted worse outcomes.
    Circulation 01/2014; · 15.20 Impact Factor
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    ABSTRACT: Background The distinction of hypertrophic cardiomyopathy (HCM) or cardiac amyloidosis (CA) from hypertensive heart disease may be difficult. The aim of this study was to determine the impact of parametric (polar) maps of regional longitudinal strain on identification of the etiology of mild to moderate left ventricular hypertrophy (LVH). Methods Twenty-four consecutive echocardiographic studies with mild to moderate LVH (eight with CA, eight with HCM, and eight with hypertensive heart disease) were selected on the basis of the availability of adequate images to assess longitudinal strain and absence of electrocardiographic criteria for low voltage or LVH or a pseudoinfarct pattern. Twenty level 3–trained readers provided the most likely of three diagnoses (CA, HCM, or hypertensive heart disease) and scored their confidence in making the diagnosis from two-dimensional images and diastolic parameters. A teaching exercise was provided on the interpretation of longitudinal strain in these cohorts, and interpretation was repeated with the addition of the strain polar map. Results Baseline concordance among the readers was poor (κ = 0.28) and improved with the addition of strain data (κ = 0.57). Accuracy was improved with the addition of polar maps for the entire study cohort (P < .001), with 22% of cases reclassified correctly. The largest improvements in sensitivity (from 40% to 86%, P < .001), specificity (from 84% to 95%, P < .001), and accuracy (from 70% to 92%, P < .001) were seen for CA. The strain polar map significantly improved reader confidence in making the correct diagnosis overall (P < .001). Conclusions Regional variations in strain are easily recognizable, accurate, and reproducible means of differentiating causes of LVH. The detection of LVH etiology may be a useful clinical application for strain.
    Journal of the American Society of Echocardiography. 01/2014;
  • Journal of the American Heart Association. 01/2014; 3(4).
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    ABSTRACT: Patients with aortic stenosis (AS) often undergo exercise echocardiography. Diastolic dysfunction (DD) is frequently associated with AS but little is known about its impact on functional capacity (FC). We sought to determine the relationship between DD and FC and their impact on mortality and need for aortic valve replacement (AVR) in patients with AS. Data was analyzed for consecutive patients with any degree of AS undergoing exercise stress echocardiography between 2000 and 2010 at our institution. The primary endpoint was a composite of death or need for AVR. We identified 1,267 patients [mean age 67±11 years, ejection fraction (56±7)%, mean aortic valve gradient 19±12 mmHg, mean maximal metabolic equivalents (METs) achieved 8±2.6]. The proportion with normal, stage 1, and ≥ stage 2 diastology was 195 (15%), 928 (73%), 144 (12%). A total of 475 (37.5%) patients had a primary outcome with 164 deaths (mean follow up 5.6±4.1 years) and 341 AVR (mean follow up 2.4±2.6 years). Predictors of FC were age, gender, body mass index, Bruce protocol, heart rate recovery (HRR), ejection fraction, mean aortic valve gradient, and diabetes but not baseline DD. Baseline DD [HR 1.82, 95% CI (1.17, 2.82), P=0.008] and FC [HR 0.93, 95% CI (0.88, 0.98), P=0.003] were independent predictors of death or AVR. For patients with AS undergoing exercise echocardiography, baseline DD was not predictive of FC. However, both baseline DD and FC were independent predictors of death or need for AVR.
    Cardiovascular diagnosis and therapy. 12/2013; 3(4):205-15.
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    ABSTRACT: In the long-term, malignancy-associated thoracic radiation leads to varying degrees of pulmonary fibrosis and radiation-associated cardiac disease, often requiring cardiothoracic surgery. We sought to determine whether pulmonary fibrosis affects mortality in patients with radiation-associated cardiac disease undergoing cardiothoracic surgery. We studied 117 patients (aged 63 ± 15 years, 71% were women) with radiation-associated cardiac disease receiving multimodality imaging who underwent cardiothoracic surgery (21% redo) between 2000 and 2003. Some 50% of patients had breast cancer, 28% of patients had Hodgkin's lymphoma, 9% of patients had lung cancer, and 13% of patients had other cancers. Time from radiation was 18 ± 12 years. Clinical, pulmonary function, angiographic, and echocardiographic parameters were recorded. On multidetector chest computed tomography, ascending aortic calcification and degree of pulmonary fibrosis (in 5 lobes for a score of 15: 0 = none, 1 = linear streaks, 2 = moderate fibrosis, and 3 = severe fibrosis with traction bronchiectasis) were recorded. Mean European System for Cardiac Operative Risk Evaluation was 7.9 ± 3, and forced expiratory volume at 1 minute/forced vital capacity ratio was 0.75 ± 0.2. Mean left ventricular ejection fraction was 49% ± 12%, and right systolic ventricular pressure was 42 ± 5 mm Hg. Some 27% of patients had severe aortic stenosis, and 46% of patients had II+ or greater mitral regurgitation. On multidetector chest computed tomography, mean pulmonary fibrosis score was 3.5 ± 3, and 59% of patients had ascending aortic calcification. Isolated coronary artery bypass was performed in 17% of patients; the rest were combination surgeries. At 6.3 ± 0.4 years, there were 59 deaths (50%) (3% died 1 month postoperatively). Forty-five patients (39%) had pulmonary complications in follow-up. Increasing pulmonary fibrosis score (hazard ratio, 1.11; 95% confidence interval, 1.02-1.20; P = .02), worse European System for Cardiac Operative Risk Evaluation (hazard ratio, 1.10; 95% confidence interval, 1.01-1.21; P = .04), and lack of beta-blocker (hazard ratio, 0.54; 95% confidence interval, 0.31-0.94, P = .008) and aspirin (hazard ratio, 0.54; 95% confidence interval, 0.31-0.94; P = .03) independently predicted mortality. In patients with radiation-associated cardiac disease undergoing cardiothoracic surgery, worsening pulmonary fibrosis is associated with increased mortality.
    The Journal of thoracic and cardiovascular surgery 11/2013; · 3.41 Impact Factor
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    ABSTRACT: Assessment of patients with aortic stenosis (AS) and impaired left ventricular function remains challenging. Aortic valve calcium (AVC) scoring with computed tomography (CT) and fluoroscopy has been proposed as means of diagnosing and predicting outcomes in patients with severe AS. Severity of aortic valve calcification correlates with the diagnosis of true severe AS and outcomes in patients with low-gradient low-flow AS. Echocardiography and CT database records from January 1, 2000 to September 26, 2009 were reviewed. Patients with aortic valve area (AVA) < 1.0 cm(2) who had ejection fraction (EF) ≤ 25% and mean valvular gradient ≤ 25 mmHg with concurrent noncontrast CT scans were included. AVC was evaluated using CT and fluoroscopy. Mortality and aortic valve replacement (AVR) were established using the Social Security Death Index and medical records. The role of surgery in outcomes was evaluated. Fifty-one patients who met the above criteria were included. Mean age was 75.1 ± 9.6 years, and 15 patients were female. Mean EF was 21% ± 4.6% with AVA of 0.7 ± 0.1 cm(2) . The peak and mean gradients were 35.5 ± 10.6 and 19.0 ± 5.1 mmHg, respectively. Median aortic valve calcium score was 2027 Agatston units. Mean follow-up was 908 days. Patients with calcium scores above the median value were found to have increased mortality (P = 0.02). The benefit of surgery on survival was more pronounced in patients with higher valvular scores (P = 0.001). Fluoroscopy scoring led to similar findings, where increased AVC predicted worse outcomes (P = 0.04). In patients with low-gradient low-flow AS, higher valvular calcium score predicts worse long-term mortality. AVR is associated with improved survival in patients with higher valve scores.
    Clinical Cardiology 10/2013; · 1.83 Impact Factor
  • Journal of the American College of Cardiology 09/2013; · 14.09 Impact Factor
  • Journal of the American College of Cardiology 07/2013; · 14.09 Impact Factor

Publication Stats

3k Citations
792.02 Total Impact Points


  • 1995–2014
    • Cleveland Clinic
      • • Department of Internal Medicine
      • • Department of Cardiovascular Medicine
      • • Department of Cardiology
      • • Center for Cardiovascular Imaging
      Cleveland, Ohio, United States
  • 2013
    • Case Western Reserve University
      Cleveland, Ohio, United States
  • 2005
    • Rice University
      Houston, Texas, United States
    • Akron General Medical Center
      Akron, Ohio, United States
  • 2001
    • Lerner Research Institute
      Cleveland, Ohio, United States
  • 1996
    • White River Junction VA Medical Center
      White River Junction, Vermont, United States