Contrast-induced acute kidney injury (CI-AKI) is an important consideration in patients undergoing cardiac catheterization. There has been a continuous strive to decrease morbidity and improve procedural safety. This review will address the pathophysiology, predictors, and clinical management of CI-AKI with a concise overview of the pathophysiology and a suggested association with left atrial appendage closure. Minimizing contrast administration and intravenous fluid hydration are the cornerstones of an effective preventive strategy. A few adjunctive pharmacotherapies hold promise, but there are no consensus recommendations on prophylactic therapies.

The incidence of fatal rAA, rTAA, and rAAA drastically decreased in the United States between 1999 and 2016, a trend that was consistent across age groups, sexes, and races. A significant percentage of fatal rAAAs occurred in patients who are not eligible for the current screening program.

Long-term therapy with MMF or tacrolimus was generally well tolerated by pediatric patients with AIH. Both MMF and tacrolimus had excellent efficacy in patients intolerant to corticosteroid or azathioprine. Tacrolimus might be more effective than MMF in patients failing previous therapy.

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The primary drawback of the previous generation of 4D ICE

We read with interest the article by Blais et al. [1] recently published in the Journal. In an analysis of a random sample of 255 patients with Nonalcoholic Fatty Liver Disease (NAFLD) in the Veteran Affairs (VA) hospital system with dyslipidemia, only 152 (59.6 %) were on statin therapy. We sought to validate these findings in larger, non-VA hospital systems in the USA. Additionally, because women are greatly underrepresented in the VA cohort (5 %), we sought to identify gender differences in statin use.We used Explorys (Cleveland, OH), a private clinical registry based on billing codes, electronic medical records, and laboratory results from 26 major healthcare organizations and 360,000 providers covering about 50 million unique lives in the USA [2]. Using International Classification of Diseases version 9 code 571.8, we identified patients with NAFLD (age 18-65 years) and low-density lipoprotein (LDL) levels of C190 mg/dL (class I indication for statin therapy in the adult treatment panel guidelines [3]). We excluded patients with AST or ALT Cthree times upper limit of normal.We identified 9960 patients with NAFLD and LDL C190 mg/dL (59 % female, 82 % Caucasians). Diabetes was diagnosed in 44 % of the patients, and 73 % had hypertension. Overall, 7030 (71 %) of the patients had a statin prescription. There was no difference in statin prescription between males and females (p = 0.86). However, African Americans had a higher rate of statin prescription than Caucasians (76 vs. 70 %, p \ 0.001).In summary, our findings of a large non-VA ''realworld'' cohort of NAFLD with significant LDL elevation showed underutilization of statin in this high-risk population. There seems to be a small racial disparity, but no gender differences were observed in statin utilization. Quality improvement projects should focus on optimization of statin utilization in this patient population.

We describe a patient with recurrent embolic strokes who was found to have a persistent left superior vena cava draining into a pulmonary vein. Transcatheter placement of a vascular plug resulted in successful occlusion of the superior vena cava. Repeat bubble study on follow-up imaging was negative for a right-to-left shunt. ( Level of Difficulty: Advanced. )

Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it is crucial to obtain the most accurate LAA dimensions to prevent intra-procedural device changes, recapture maneuvers, and prolonged procedure time. We therefore sought to examine the accuracy of the most commonly utilized imaging modalities in LAA occlusion. Institutional Review Board (IRB) approval was waived as we only reviewed published data. By utilizing PUBMED which is an integrated online website to list the published literature based on its relevance, we retrieved thirty-two articles on the accuracy of most commonly used imaging modalities for pre-procedural assessment of the left atrial appendage morphology, namely, two-dimensional transesophageal echocardiography, three-dimensional transesophageal echocardiography, computed tomography, and three-dimensional printing. There is strong evidence that real-time three-dimensional transesophageal echocardiography is more accurate than two-dimensional transesophageal echocardiography. Three-dimensional computed tomography has recently emerged as an imaging modality and it showed exceptional accuracy when merged with three-dimensional printing technology. However, real time three-dimensional transesophageal echocardiography may be considered the preferred imaging modality as it can provide accurate measurements without requiring radiation exposure or contrast administration. We will present the most common imaging modality used for LAA assessment and will provide an algorithmic approach including preprocedural, periprocedural, intraprocedural, and postprocedural.