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Cecilio (Leo) Lopez, MD

Specialties

Cardiology

Work and Education

Professional Education

Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, 5/18/1987

Residency

Boston Childrens Hospital Pediatric Residency, Boston, MA, 6/30/1990

Fellowship

Boston Childrens Hospital Pediatric Cardiology Fellowship, Boston, MA, 6/30/1994

Board Certifications

Pediatric Cardiology, American Board of Pediatrics

All Publications

Challenges and lessons learned from the Pediatric Heart Network Normal Echocardiogram Database study. Cardiology in the young Truong, D., Lopez, L., Frommelt, P. C., Stelter, J., Ni, B., Cohen, M. S., Prakash, A., Colan, S. D., Spurney, C., Soslow, J., Pearson, G. D., Mahgerefteh, J., Sachdeva, R., Pignatelli, R., Trachtenberg, F., Stylianou, M., Altmann, K., Rathge, K. A., Camarda, J., Chowdhury, S., Dragulescu, A., Frommelt, M., Garuba, O., Soriano, B., Srivastava, S., Thankavel, P., van der Velde, M. E., Minich, L. L., Pediatric Heart Network Investigators 2020: 16

Abstract

BACKGROUND: The Pediatric Heart Network Normal Echocardiogram Database Study had unanticipated challenges. We sought to describe these challenges and lessons learned to improve the design of future studies.METHODS: Challenges were divided into three categories: enrolment, echocardiographic imaging, and protocol violations. Memoranda, Core Lab reports, and adjudication logs were reviewed. A centre-level questionnaire provided information regarding local processes for data collection. Descriptive statistics were used, and chi-square tests determined differences in imaging quality.RESULTS: For the 19 participating centres, challenges with enrolment included variations in Institutional Review Board definitions of "retrospective" eligibility, overestimation of non-White participants, centre categorisation of Hispanic participants that differed from National Institutes of Health definitions, and exclusion of potential participants due to missing demographic data. Institutional Review Board amendments resolved many of these challenges. There was an unanticipated burden imposed on centres due to high numbers of echocardiograms that were reviewed but failed to meet submission criteria. Additionally, image transfer software malfunctions delayed Core Lab image review and feedback. Between the early and late study periods, the proportion of unacceptable echocardiograms submitted to the Core Lab decreased (14 versus 7%, p < 0.01). Most protocol violations were from eligibility violations and inadvertent protected health information disclosure (overall 2.5%). Adjudication committee reviews led to protocol changes.CONCLUSIONS: Numerous challenges encountered during the Normal Echocardiogram Database Study prolonged study enrolment. The retrospective design and flaws in image transfer software were key impediments to study completion and should be considered when designing future studies collecting echocardiographic images as a primary outcome.

View details for DOI 10.1017/S1047951120000438

View details for PubMedID 32180543

ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Sachdeva, R., Valente, A., Armstrong, A. K., Cook, S. C., Han, B., Lopez, L., Lui, G. K., Pickard, S. S., Powell, A. J., Bhave, N. M., Pickard, S. S., Baffa, J. M., Banka, P., Cohen, S. B., Glickstein, J. S., Kanter, J. P., Kanter, R. J., Kim, Y. Y., Kipps, A. K., Latson, L. A., Lin, J. P., Parra, D. A., Rodriguez, F. H., Saarel, E. V., Srivastava, S., Stephenson, E. A., Stout, K. K., Zaidi, A. N., Gluckman, T. J., Aggarwal, N. R., Bhave, N. M., Dehmer, G. J., Gilbert, O. N., Kumbhani, D. J., Price, A. L., Winchester, D. E., Gulati, M., Dehmer, G. J., Doherty, J. U., Bhave, N. M., Daugherty, S. L., Dean, L. S., Desai, M. Y., Gillam, L. D., Mehrotra, P. 2020; 75 (6): 657703

View details for DOI 10.1016/j.jacc.2019.10.002

View details for Web of Science ID 000512903000013

View details for PubMedID 31918898

Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Frommelt, P., Lopez, L., Dimas, V. V., Eidem, B., Han, B. K., Ko, H. H., Lorber, R., Nii, M., Printz, B., Srivastava, S., Valente, A. M., Cohen, M. S. 2020; 33 (3): 25994

View details for DOI 10.1016/j.echo.2019.10.011

View details for PubMedID 32143778

2019 ACC/AHA/ASE Key Data Elements and Definitions for Transthoracic Echocardiography A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Transthoracic Echocardiography) and the American Society of Echocardiography JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY Douglas, P. S., Carabello, B. A., Lang, R. M., Lopez, L., Pellikka, P. A., Picard, M. H., Thomas, J. D., Varghese, P., Wang, T. Y., Weissman, N. J., Wilgus, R., Bozkurt, B., Jneid, H., Al-Khatib, S. M., Anderson, H., Gilstrap, L., Graham, G. N., Jones, G. K., Kao, D., Lopez, L., Marcus, G., Rymer, J., Tcheng, J. E., Weintraub, W. S. 2019; 32 (9): 11611248

View details for DOI 10.1016/j.echo.2019.05.006

View details for Web of Science ID 000484074400016

View details for PubMedID 31248777

How Well Does the Neonatal Heart Measure Up? Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Lopez, L., Colan, S. D. 2019; 32 (7): 9068

View details for DOI 10.1016/j.echo.2019.04.423

View details for PubMedID 31272594

2019 ACC/AHA/ASE Key Data Elements and Definitions for Transthoracic Echocardiography: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Transthoracic Echocardiography) and the American Society of Echocardiography CIRCULATION-CARDIOVASCULAR IMAGING Douglas, P. S., Carabello, B. A., Lang, R. M., Lopez, L., Pellikka, P. A., Picard, M. H., Thomas, J. D., Varghese, P., Wang, T. Y., Weissman, N. J., Wilgus, R. 2019; 12 (7): e000027

View details for DOI 10.1161/HCI.0000000000000027

View details for Web of Science ID 000475945900002

View details for PubMedID 31233331

Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Frommelt, P. C., Minich, L. L., Trachtenberg, F. L., Altmann, K., Camarda, J., Cohen, M. S., Colan, S. D., Dragulescu, A., Frommelt, M. A., Johnson, T. R., Kovalchin, J. P., Lin, L., Mahgerefteh, J., Nutting, A., Parra, D. A., Pearson, G. D., Pignatelli, R., Sachdeva, R., Soriano, B. D., Spurney, C., Srivastava, S., Statile, C. J., Stelter, J., Stylianou, M., Thankavel, P. P., Tierney, E. S., van der Velde, M. E., Lopez, L. 2019

Abstract

The reliability of left ventricular (LV) systolic functional indices calculated from blinded echocardiographic measurements of LV size has not been tested in a large cohort of healthy children. The objective of this study was to estimate interobserver variability in standard measurements of LV size and systolic function in children with normal cardiac anatomy and qualitatively normal function.The Pediatric Heart Network Normal Echocardiogram Database collected normal echocardiograms from healthy children 18years old distributed equally by age, gender, and race. A core lab used two-dimensional echocardiograms to measure LV dimensions from which a separate data coordinating center calculated LV volumes and systolic functional indices. To evaluate interobserver variability, two independent expert pediatric echocardiographic observers remeasured LV dimensions on a subset of studies, while blinded to calculated volumes and functional indices.Of 3,215 subjects with measurable images, 552 (17%) had a calculated LV shortening fraction (SF)<25% and/or LV ejection fraction (EF)<50%; the subjects were significantly younger and smaller than those with normal values. When the core lab and independent observer measurements were compared, individual LV size parameter intraclass correlation coefficients were high (0.81-0.99), indicating high reproducibility. The intraclass correlation coefficients were lower for SF (0.24) and EF (0.56). Comparing reviewers, 40/56 (71%) of those with an abnormal SF and 36/104 (35%) of those with a normal SF based on core lab measurements were calculated as abnormal from at least one independent observer. In contrast, an abnormal EF was less commonly calculated from the independent observers' repeat measures; only 9/47 (19%) of those with an abnormal EF and 8/113 (7%) of those with a normal EF based on core lab measurements were calculated as abnormal by at least one independent observer.Although blinded measurements of LV size show good reproducibility in healthy children, subsequently calculated LV functional indices reveal significant variability despite qualitatively normal systolic function. This suggests that, in clinical practice, abnormal SF/EF values may result in repeat measures of LV size to match the subjective assessment of function. Abnormal LV functional indices were more prevalent in younger, smaller children.

View details for DOI 10.1016/j.echo.2019.05.025

View details for PubMedID 31351792

Echocardiographic surveillance in children after tetralogy of Fallot repair: Adherence to guidelines? International journal of cardiology Annavajjhala, V., Valente, A. M., Lopez, L., Sachdeva, R., Glickstein, J. S., Natarajan, S. S., Buddhe, S., Altmann, K., Soriano, B. D., Colquitt, J. L., Altman, C. A., Sasaki, N., Sakarovitch, C., Tacy, T. A., Geva, T., Selamet Tierney, E. S. 2019

Abstract

Longitudinal clinical surveillance by transthoracic echocardiography (TTE) is an established practice in children with repaired tetralogy of Fallot (TOF). Non-Invasive Imaging Guidelines recommends a list of reporting elements that should be addressed during routine TTE in this population. In this study, we assessed the adherence to these recommendations.This was a multi-center (n=8) retrospective review of TTE reports in children 11 years of age who have had complete TOF repair. We included 10 patients from each participating center (n=80) and scored 2 outpatient follow-up TTE reports on each patient. The adherence rate was based on completeness of TTE reporting elements derived from the guidelines.We reviewed 160 TTE reports on 80 patients. Median age was 4.4 months (IQR 1.5-6.6) and 3.6 years (IQR 1.3-6.4) at the time of complete surgical repair and first TTE report, respectively. The median adherence rate to recommended reporting elements was 61% (IQR 53-70). Of the 160 reports, 9 (7%) were 80% adherent and 40 (25%) were 70% adherent. Quantitative measurements of right ventricular outflow tract (RVOT), right ventricular (RV) size and function, and branch pulmonary arteries were least likely to be reported.Overall adherence to the most recent published imaging guidelines for surveillance of children with repaired TOF patients was suboptimal, especially for reporting of RVOT, RV size and function, and branch pulmonary arteries. Further studies are needed to explore the barriers to adherence to guidelines and most importantly, whether adherence is associated with clinical outcomes.

View details for DOI 10.1016/j.ijcard.2019.09.075

View details for PubMedID 31668657

Cardiovascular imaging in Turner syndrome: state-of-the-art practice across the lifespan. Heart (British Cardiac Society) Mortensen, K. H., Young, L., De Backer, J., Silberbach, M., Collins, R. T., Duijnhouwer, A. L., Pandya, B., Gravholt, C. H., Lopez, L., Roos-Hesselink, J. W. 2018; 104 (22): 182331

Abstract

Cardiovascular imaging is essential to providing excellent clinical care for girls and women with Turner syndrome (TS). Congenital and acquired cardiovascular diseases are leading causes of the lifelong increased risk of premature death in TS. Non-invasive cardiovascular imaging is crucial for timely diagnosis and treatment planning, and a systematic and targeted imaging approach should combine echocardiography, cardiovascular magnetic resonance and, in select cases, cardiac CT. In recent decades, evidence has mounted for the need to perform cardiovascular imaging in all females with TS irrespective of karyotype and phenotype. This is due to the high incidence of outcome-determining lesions that often remain subclinical and occur in patterns specific to TS. This review provides an overview of state-of-the-art cardiovascular imaging practice in TS, by means of a review of the most recent literature, in the context of a recent consensus statement that has highlighted the role of cardiovascular diseases in these females.

View details for PubMedID 30228249

Classification of Ventricular Septal Defectsforthe Eleventh Iteration of the International Classification of Diseases-Striving for Consensus: A Report From the International Society for Nomenclature of Paediatric and Congenital Heart Disease. The Annals of thoracic surgery Lopez, L., Houyel, L., Colan, S. D., Anderson, R. H., Bland, M. J., Aiello, V. D., Bailliard, F., Cohen, M. S., Jacobs, J. P., Kurosawa, H., Sanders, S. P., Walters, H. L., Weinberg, P. M., Boris, J. R., Cook, A. C., Crucean, A., Everett, A. D., Gaynor, J. W., Giroud, J., Guleserian, K. J., Hughes, M. L., Juraszek, A. L., Krogmann, O. N., Maruszewski, B. J., St Louis, J. D., Seslar, S. P., Spicer, D. E., Srivastava, S., Stellin, G., Tchervenkov, C. I., Wang, L., Franklin, R. C. 2018; 106 (5): 157889

Abstract

The definition and classification of ventricular septal defects have been fraught with controversy. The International Society for Nomenclature of Paediatric and Congenital Heart Disease is a group of international specialists in pediatric cardiology, cardiac surgery, cardiac morphology, and cardiac pathology that has met annually for the past 9 years in an effort to unify by consensus the divergent approaches to describe ventricular septal defects. These efforts have culminated in acceptance of the classification system by the World Health Organization into the 11th Iteration of the International Classification of Diseases. The scheme to categorize a ventricular septal defect uses both its location and the structures along its borders, thereby bridging the two most popular and disparate classification approaches and providing a common language for describing each phenotype. Although the first-order terms are based on the geographic categories of central perimembranous, inlet, trabecular muscular, and outlet defects, inlet and outlet defects are further characterized by descriptors that incorporate the borders of the defect, namely the perimembranous, muscular, and juxta-arterial types. The Society recognizes that it is equally valid to classify these defects by geography or borders, so the emphasis in this system is on the second-order terms that incorporate both geography and borders to describe each phenotype. The unified terminology should help the medical community describe with better precision all types of ventricular septal defects.

View details for DOI 10.1016/j.athoracsur.2018.06.020

View details for PubMedID 30031844

Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association. Circulation. Genomic and precision medicine Silberbach, M., Roos-Hesselink, J. W., Andersen, N. H., Braverman, A. C., Brown, N., Collins, R. T., De Backer, J., Eagle, K. A., Hiratzka, L. F., Johnson, W. H., Kadian-Dodov, D., Lopez, L., Mortensen, K. H., Prakash, S. K., Ratchford, E. V., Saidi, A., van Hagen, I., Young, L. T. 2018; 11 (10): e000048

Abstract

Girls and women with Turner syndrome face a lifelong struggle with both congenital heart disease and acquired cardiovascular conditions. Bicuspid aortic valve is common, and many have left-sided heart obstructive disease of varying severity, from hypoplastic left-sided heart syndrome to minimal aortic stenosis or coarctation of the aorta. Significant enlargement of the thoracic aorta may progress to catastrophic aortic dissection and rupture. It is becoming increasingly apparent that a variety of other cardiovascular conditions, including early-onset hypertension, ischemic heart disease, and stroke, are the major factors reducing the life span of those with Turner syndrome. The presentations and management of cardiovascular conditions in Turner syndrome differ significantly from the general population. Therefore, an international working group reviewed the available evidence regarding the diagnosis and treatment of cardiovascular diseases in Turner syndrome. It is recognized that the suggestions for clinical practice stated here are only the beginning of a process that must also involve the establishment of quality indicators, structures and processes for implementation, and outcome studies.

View details for DOI 10.1161/HCG.0000000000000048

View details for PubMedID 30354301

Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database. Circulation. Cardiovascular imaging Lopez, L., Colan, S., Stylianou, M., Granger, S., Trachtenberg, F., Frommelt, P., Pearson, G., Camarda, J., Cnota, J., Cohen, M., Dragulescu, A., Frommelt, M., Garuba, O., Johnson, T., Lai, W., Mahgerefteh, J., Pignatelli, R., Prakash, A., Sachdeva, R., Soriano, B., Soslow, J., Spurney, C., Srivastava, S., Taylor, C., Thankavel, P., van der Velde, M., Minich, L. 2017; 10 (11)

Abstract

Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity.Data collected from healthy nonobese children 18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSA) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5% difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as 5% difference. Of the 3566 subjects, 90% had measurable images. Appropriate BSA transformations (BSA) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement.Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.

View details for DOI 10.1161/CIRCIMAGING.117.006979

View details for PubMedID 29138232

View details for PubMedCentralID PMC5812349

Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Lopez, L., Colan, S. D., Frommelt, P. C., Ensing, G. J., Kendall, K., Younoszai, A. K., Lai, W. W., Geva, T. 2010; 23 (5): 46595; quiz 57677

View details for DOI 10.1016/j.echo.2010.03.019

View details for PubMedID 20451803