Rudy R. Unni, MD, FRCP

All Publications

• Beyond Subjectivity: Toward Equity in the Psychosocial Assessment for Heart Transplantation. Journal of cardiac failure Unni, R. R., Stott, K., Teuteberg, J., Khush, K. K. 2025

  View details for DOI 10.1016/j.cardfail.2025.11.485

  View details for PubMedID 41271154

• Mechanistic classification of isolated severe aortic regurgitation in a contemporary cohort of patients EUROPEAN HEART JOURNAL OPEN Unni, R. R., Boodhwani, M., Jelaidan, I., Harnett, D. T., Massalha, S., Liang, C., Prosperi-Porta, G., Glineur, D., Burwash, I. G., Chan, K., Coutinho, T., Fu, A., Willner, N., Messika-Zeitoun, D., Beauchesne, L. 2025; 5 (3)

  View details for DOI 10.1093/ehjopen/oeaf042

  View details for Web of Science ID 001487824500001

• Challenges in the Evaluation of Aortic Stenosis: A Guide to Multimodal Imaging. The Canadian journal of cardiology Durr, M. R., Burwash, I. G., Tavoosi, A., Prosperi-Porta, G., Santi, N., Unni, R. R., Lopez Laporte, M. A., Sharma, A. N., Aljamaan, A., Paterson, I. D., Chan, K. L., Andrew Mulloy, L. B., Alfraidi, H., Lau, L., Froeschl, M., Messika-Zeitoun, D. 2024; 40 (12): 2631-2634

  View details for DOI 10.1016/j.cjca.2024.10.008

  View details for PubMedID 39396771

• Computed simulation of transcatheter edge-to-edge mitral valve repair. European heart journal. Cardiovascular Imaging Messika-Zeitoun, D., Mousavi, J., Le Dolley, Y., Houel, R., Mesana, T. 2024; 25 (7): e190

  View details for DOI 10.1093/ehjci/jeae062

  View details for PubMedID 38445530

• Female-Specific Considerations in Aortic Health and Disease. CJC open Crosier, R., Lopez Laporte, M. A., Unni, R. R., Coutinho, T. 2024; 6 (2Part B): 391-406

  Abstract

  The aorta plays a central role in the modulation of blood flow to supply end organs and to optimize the workload of the left ventricle. The constant interaction of the arterial wall with protective and deleterious circulating factors, and the cumulative exposure to ventriculoarterial pulsatile load, with its associated intimal-medial changes, are important players in the complex process of vascular aging. Vascular aging is also modulated by biomolecular processes such as oxidative stress, genomic instability, and cellular senescence. Concomitantly with well-established cardiometabolic and sex-specific risk factors and environmental stressors, arterial stiffness is associated with cardiovascular disease, which remains the leading cause of morbidity and mortality in women worldwide. Sexual dimorphisms in aortic health and disease are increasingly recognized and explain-at least in part-some of the observable sex differences in cardiovascular disease, which will be explored in this review. Specifically, we will discuss how biological sex affects arterial health and vascular aging and the implications this has for development of certain cardiovascular diseases uniquely or predominantly affecting women. We will then expand on sex differences in thoracic and abdominal aortic aneurysms, with special considerations for aortopathies in pregnancy.

  View details for DOI 10.1016/j.cjco.2023.09.006

  View details for PubMedID 38487044

  View details for PubMedCentralID PMC10935703

• Aortic Stenosis Progression: A Systematic Review and Meta-Analysis. JACC. Cardiovascular imaging Willner, N., Prosperi-Porta, G., Lau, L., Nam Fu, A. Y., Boczar, K., Poulin, A., Di Santo, P., Unni, R. R., Visintini, S., Ronksley, P. E., Chan, K. L., Beauchesne, L., Burwash, I. G., Messika-Zeitoun, D. 2023; 16 (3): 314-328

  Abstract

  Aortic valve stenosis is a progressive disorder with variable progression rates. The factors affecting aortic stenosis (AS) progression remain largely unknown.This systematic review and meta-analysis sought to determine AS progression rates and to assess the impact of baseline AS severity and sex on disease progression.The authors searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 1, 2020, for prospective studies evaluating the progression of AS with the use of echocardiography (mean gradient [MG], peak velocity [PV], peak gradient [PG], or aortic valve area [AVA]) or computed tomography (calcium score [AVC]). Random-effects meta-analysis was performed to evaluate the rate of AS progression for each parameter stratified by baseline severity, and meta-regression was performed to determine the impact of baseline severity and of sex on AS progression rate.A total of 24 studies including 5,450 patients (40% female) met inclusion criteria. The pooled annualized progression of MG was +4.10 mm Hg (95% CI: 2.80-5.41 mm Hg), AVA -0.08 cm2 (95% CI: 0.06-0.10 cm2), PV +0.19 m/s (95% CI: 0.13-0.24 m/s), PG +7.86 mm Hg (95% CI: 4.98-10.75 mm Hg), and AVC +158.5 AU (95% CI: 55.0-261.9 AU). Increasing baseline severity of AS was predictive of higher rates of progression for MG (P < 0.001), PV (P = 0.001), and AVC (P < 0.001), but not AVA (P = 0.34) or PG (P = 0.21). Only 4 studies reported AS progression stratified by sex, with only PV and AVC having 3 studies to perform a meta-analysis. No difference between sex was observed for PV (P = 0.397) or AVC (P = 0.572), but the level of confidence was low.This study provides progression rates for both hemodynamic and anatomic parameters of AS and shows that increasing hemodynamic and anatomic baseline severity is associated with faster AS progression. More studies are needed to determine if sex differences affect AS progression. (Aortic Valve Stenosis Progression Rate: A Systematic Review and Meta-Analysis; CRD42021207726).

  View details for DOI 10.1016/j.jcmg.2022.10.009

  View details for PubMedID 36648053

• Mechanistic Classification and Outcomes of Isolated Aortic Regurgitation in a Contemporary Cohort of Patients Unni, R. R., Liang, J., Jelaidan, I., Harnett, D., Boodhwani, M., Glineur, D., Burwash, I. G., Chan, K. L., Coutinho, T., Prosperi-Porta, G., Fu, A., Willner, N., Messika-Zeitoun, D., Beauchesne, L. M. LIPPINCOTT WILLIAMS & WILKINS. 2022: A14451

  View details for DOI 10.1161/circ.146.suppl_1.14451

  View details for Web of Science ID 001839871600001

• Rhythm-Monitoring Strategy and Arrhythmia Recurrence in Atrial Fibrillation Ablation Trials: A Systematic Review. CJC open Unni, R. R., Prager, R. T., Odabashian, R., Zhang, J. J., Fat Hing, N. N., Nery, P. B., Pi, L., Aldawood, W., Sadek, M. M., Redpath, C. J., Birnie, D. H., Alqarawi, W., Zagzoog, A., Golian, M., Klein, A., Ramirez, F. D., Green, M. S., Chen, L., Visintini, S., Wells, G. A., Nair, G. M. 2022; 4 (5): 488-496

  Abstract

  : The rhythm-monitoring strategy after catheter ablation (CA) for atrial fibrillation (AF) impacts the detection of atrial arrhythmia recurrence and is not well characterized. We performed a systematic review and meta-regression analysis to determine whether the duration and mode of rhythm monitoring after CA affects detection of atrial arrhythmia recurrence.Databases were systematically searched for randomized controlled trials of adult patients undergoing first CA for AF from 2007 to 2021. Duration and strategy of rhythm monitoring were extracted. Meta-regression was used to identify any association between duration of monitoring and detection of atrial arrhythmia recurrence. The primary measure of outcome was single-procedure recurrence of atrial arrhythmia.The search strategy yielded 57 trial arms from 56 randomized controlled trials comprising 5322 patients: 36 arms of patients with paroxysmal AF (PAF), and 21 arms of patients with persistent AF (PeAF) or both PAF/PeAF. Intermittent monitoring was associated with detection of significantly less atrial arrhythmia recurrence than continuous monitoring in PAF arms (31.2% vs 46.9%, P = 0.001), but not in PeAF/PAF-PeAF combined arms (43.3% vs 63.6%, P = 0.12). No significant relationship was seen between the duration of intermittent rhythm monitoring and atrial arrhythmia recurrence detection in either the PAF (P = 0.93) or PeAF/PAF-PeAF combined arms (P = 0.20).Continuous rhythm monitoring detected higher atrial arrhythmia recurrence rates, compared to intermittent rhythm monitoring, in patients with PAF. The duration of intermittent monitoring did not show a statistically significant relationship to the yield of arrhythmia detection, in near identical cohorts of trial subjects undergoing similar interventions, with clinical and research implications.

  View details for DOI 10.1016/j.cjco.2022.02.001

  View details for PubMedID 35607484

  View details for PubMedCentralID PMC9123375

• Gamification of an Interdisciplinary Point-of-Care Ultrasound Symposium and Its Perceived Impact on Learning Zhang, J., Unni, R. R., Curley, E., Dadgar, K., Park, S. W., Maniate, J., Hallman, S., Prager, R. Canadian Journal of Medical Sonography. 2022
• Post cardiac arrest care in 2021: Back to the drawing board. Resuscitation Unni, R. R., Russo, J. J. 2021; 169: 185-186

  View details for DOI 10.1016/j.resuscitation.2021.09.016

  View details for PubMedID 34592403

• Duration of Rhythm Monitoring and Arrhythmia Recurrence After Pulmonary Vein Isolation for Atrial Fibrillation: A Systematic Review and Meta-Regression Study Unni, R. R., Odabashian, R., Prager, R., Zhang, J. J., Hing, N., Pi, L., Chen, L., Wells, G., Nair, G. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for Web of Science ID 000752020003002

• Barriers to reporting guideline adherence in point-of-care ultrasound research: a cross-sectional survey of authors and journal editors BMJ EVIDENCE-BASED MEDICINE Prager, R., Gagnon, L., Bowdridge, J., Unni, R. R., McGrath, T. A., Cobey, K., Bossuyt, P. M., McInnes, M. D. F. 2021; 26 (4)

  Abstract

  Although the literature supporting the use of point-of-care ultrasound (POCUS) continues to grow, incomplete reporting of primary diagnostic accuracy studies has previously been identified as a barrier to translating research into practice and to performing unbiased systematic reviews. This study assesses POCUS investigator and journal editor attitudes towards barriers to adhering to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines.Two separate surveys using a 5-point Likert scale were sent to POCUS study investigators and journal editors to assess for knowledge, attitude and behavioural barriers to the complete reporting of POCUS research. Respondents were identified based on a previous study assessing STARD 2015 adherence for POCUS studies published in emergency medicine, anaesthesia and critical care journals. Responses were anonymously linked to STARD 2015 adherence data from the previous study. Written responses were thematically grouped into the following categories: knowledge, attitude and behavioural barriers to quality reporting, or other. Likert response items are reported as median with IQRs.The primary outcome was the median Likert score for the investigator and editor surveys assessing knowledge, attitude and behavioural beliefs about barriers to adhering to the STARD 2015 guidelines.The investigator survey response rate was 18/69 (26%) and the editor response rate was 5/21 (24%). Most investigator respondents were emergency medicine practitioners (13/21, 62%). Two-thirds of investigators were aware of the STARD 2015 guidelines (12/18, 67%) and overall agreed that incomplete reporting limits generalisability and the ability to detect risk of bias (median 4 (4, 5)). Investigators felt that the STARD 2015 guidelines were useful, easy to find and easy to use (median 4 (4, 4.25); median 4 (4, 4.25) and median 4 (3, 4), respectively). There was a shared opinion held by investigators and editors that the peer review process be primarily responsible for ensuring complete research reporting (median 4 (3, 4) and median 4 (3.75, 4), respectively). Three of 18 authors (17%) felt that the English publication language of STARD 2015 was a barrier to adherence.Although investigators and editors recognise the importance of completely reported research, reporting quality is still a core issue for POCUS research. The shared opinion held by investigators and editors that the peer review process be primarily responsible for reporting quality is potentially problematic; we view completely reported research as an integral part of the research process that investigators are responsible for, with the peer review process serving as another additional layer of quality control. Endorsement of reporting guidelines by journals, auditing reporting guideline adherence during the peer review process and translation of STARD 2015 guidelines into additional languages may improve reporting completeness for the acute POCUS literature.Open Science Framework Registry (https://osf.io/5pzxs/).

  View details for DOI 10.1136/bmjebm-2020-111604

  View details for Web of Science ID 000678426700015

  View details for PubMedID 33483335

• Blinding practices during acute point-of-care ultrasound research: the BLIND-US meta-research study BMJ EVIDENCE-BASED MEDICINE Prager, R., Wu, K., Bachar, R., Unni, R. R., Bowdridge, J., McGrath, T. A., Thavanathan, R., Woo, M. Y., McInnes, M. D. F. 2021; 26 (3): 110-+

  Abstract

  Point-of-care ultrasound (POCUS) diagnostic accuracy research has significant variation in blinding practices. This study characterises the blinding practices during acute POCUS research to determine whether research methodology adequately reflects POCUS use in routine clinical practice.A search for POCUS diagnostic accuracy studies published in Emergency Medicine, Anaesthesia and Critical Care journals from January 2016 to January 2020 was performed. Studies were included if they were primary diagnostic accuracy studies. The study year, journal impact factor, population, hospital area, body region, study design, blinding of the POCUS interpreter to clinical information, whether the person performing the POCUS scan was the same person interpreting the scan, and whether the study reported incremental diagnostic yield were extracted in duplicate by two authors. Descriptive statistics were provided and prespecified subgroup analysis was performed.The primary outcome was the number of studies that blinded the POCUS interpreter to at least some part of the clinical information. Secondary outcomes included whether the person performing the POCUS scan was the same person interpreting it and whether the study reported incremental diagnostic yield.520 abstracts were screened with 97 studies included. The POCUS interpreter was blinded to clinical information in 37 studies (38.1%), not blinded in 34 studies (35.1%) and not reported in 26 studies (26.8%). The POCUS interpreter was the same person obtaining the images in 72 studies (74.2%), different in 14 studies (14.4%) and not reported in 11 studies (11.3%). Only four studies (4.1%) reported incremental diagnostic yield for POCUS. Inter-rater reliability was moderate (k=0.64). Subgroup analysis based on impact factor, body region, hospital area, patient population and study design did not show significant differences after completing pairwise comparisons.Although blinding the POCUS interpreter to clinical information may be done in a perceived attempt to limit bias, this may result in accuracy estimates that do not reflect routine clinical practice. Similarly, having a different clinician perform and interpret the POCUS scan significantly limits generalisability to practice as it does not truly reflect 'point-of-care' ultrasound at all. Reporting incremental diagnostic yield from implementing POCUS into a diagnostic pathway better reflects the value of POCUS; however, this methodology was infrequently used.The study protocol was registered on Open Science Framework (https://osf.io/h5fe7/).

  View details for DOI 10.1136/bmjebm-2020-111577

  View details for Web of Science ID 000656481900013

  View details for PubMedID 33177166

• Content Analysis and Characterization of Medical Tweets During the Early Covid-19 Pandemic CUREUS JOURNAL OF MEDICAL SCIENCE Prager, R., Pratte, M. T., Unni, R. R., Bala, S., Hing, N., Wu, K., McGrath, T. A., Thomas, A., Thoma, B., Kyeremanteng, K. 2021; 13 (2)

  View details for DOI 10.7759/cureus.13594

  View details for Web of Science ID 000624939600013

• Variations in stepped-wedge cluster randomized trial design: Insights from the Patient-Centered Care Transitions in Heart Failure trial AMERICAN HEART JOURNAL Unni, R. R., Lee, S., Thabane, L., Connolly, S., Van Spall, H. G. C. 2020; 220: 116-126

  Abstract

  The stepped-wedge (SW) cluster randomized controlled trial, in which clusters cross over in a randomized sequence from control to intervention, is ideal for the implementation and testing of complex health service interventions. In certain cases however, implementation of the intervention may pose logistical challenges, and variations in SW design may be required. We examine the logistical and statistical implications of variations in SW design using the optimization of the Patient-Centered Care Transitions in Heart Failure trial for illustration. We review the following complete SW design variations: a typical SW design; an SW design with multiple clusters crossing over per period to achieve balanced cluster sizes at each step; hierarchical randomization to account for higher-level clustering effects; nested substudies to measure outcomes requiring a smaller sample size than the primary outcomes; and hybrid SW design, which combines parallel cluster with SW design to improve efficiency. We also reviewed 3 incomplete SW design variations in which data are collected in some but not all steps to ease measurement burden. These include designs with a learning period that improve fidelity to the intervention, designs with reduced measurements to minimize collection burden, and designs with early and late blocks to accommodate cluster readiness. Variations in SW design offer pragmatic solutions to logistical challenges but have implications to statistical power. Advantages and disadvantages of each variation should be considered before finalizing the design of an SW randomized controlled trial.

  View details for DOI 10.1016/j.ahj.2019.08.017

  View details for Web of Science ID 000510852400014

  View details for PubMedID 31805422

• Altmetrics of COVID-19 research: An analysis of study dissemination by Twitter compared to citation rates Fabiano, N., Hallgrimson, Z., Kazi, S., Salameh, J., Wong, S., Kazi, A., Unni, R., Prager, R., McInnes , M. MedRXiv doi: 10.1101/2020.06.22.20137505. 2020
• University of Ottawa Core Internal Medicine Resident Handbook Unni, R. University of Ottawa . 2019

  Abstract

  (1st Ed 2019-2020; 2nd Edition 2020-2021)

• Electromyographic assessment of isometric and dynamic activation characteristics of the latissimus dorsi muscle JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY Beaudette, S. M., Unni, R., Brown, S. H. M. 2014; 24 (3): 430-436

  Abstract

  The aim of the current study was to analyze the activation characteristics and potential compartmentalization of the latissimus dorsi (LD) muscle during common maximal voluntary isometric contractions (MVICs) and functional dynamic tasks. Surface electromyography (sEMG) was used to measure activation magnitudes from four electrode sites (referenced to the T10, T12, L1 & L4 LD vertebral origins) across the fanning muscle belly of the LD. In addition, EMG waveforms were cross-correlated to study temporal activation timing between electrode sites (T10-T12, T12-L1, L1-L4 & T10-L4). The MVICs that were tested included a humeral adduction, humeral adduction with internal rotation, a chest-supported row and a humeral extension. Dynamic movements included sagittal lift/lowers from the floor to knee, knee to hip and hip to shoulder. No magnitude-based (p=0.6116) or temporal-based differences were observed between electrode sites during the MVIC trials. During dynamic movements no temporal-based, but some magnitude-based differences between electrode sites were observed to be present; these differences were small in magnitude and were observed for both the maximum (p=0.0002) and mean (p=0.0002) EMG magnitudes. No clear pattern of compartmentalization was uncovered in the contractions studied here. In addition to these findings, it was determined that the most effective MVIC technique for LD EMG normalization purposes was a chest-supported row MVIC, paired with a T12 electrode site.

  View details for DOI 10.1016/j.jelekin.2014.03.006

  View details for Web of Science ID 000335512600015

  View details for PubMedID 24735642