About

Dr. Smadar Kort is a Professor of Medicine at Stony Brook University Hospital with a focus on cardiology, particularly in the field of echocardiography. Her goal is to establish a state-of-the-art echo lab at Stony Brook University Hospital and to deliver cutting-edge technology to patients. She specializes in the rapidly developing field of echocardiography, utilizing new modalities to diagnose various cardiac conditions at an earlier stage and to guide innovative therapeutic cardiac procedures. Her academic background includes fellowships in Echocardiography at NYU Langone Medical Center and in Internal Medicine-Cardiology at Cornell University New York Hospital, where she also completed her residency and internship. She earned her medical degree from Tel Aviv University Sackler School of Medicine. Dr. Kort is board-certified in Adult Comprehensive Echocardiography by the National Board of Echocardiography and in Cardiovascular Disease by the American Board of Internal Medicine. Her research and clinical interests encompass advanced echocardiographic techniques, including real-time three-dimensional stress echocardiography, speckle tracking imaging, and intracardiac echocardiography, with a focus on improving diagnostic accuracy and patient outcomes in cardiac care.

Research topics

• Medicine
• Cardiology
• Medical emergency
• Internal medicine
• Radiology
• Intensive care medicine
• Virology
• Pathology
• Computer Security
• Anatomy
• Law
• Medical physics

Selected publications

• Artificial Intelligence–Enhanced Cardiac Point-of-Care Ultrasound: A Prospective Single-Arm Study

  Mayo Clinic Proceedings Digital Health · 2026-03-31

  articleOpen access

  Objective: To evaluate the clinical utility of combining artificial intelligence (AI) with handheld focused cardiac ultrasound (FoCUS) performed by noncardiologist physicians in clinical care settings. Patients and Methods: In this prospective, single-arm study conducted from July 1, 2022, through December 31, 2023 (ClinicalTrials.gov NCT05455541), 660 adult patients presenting to the emergency department or internal medicine wards were assessed with handheld ultrasound devices enhanced by AI algorithms. These algorithms provided automated analysis of ventricular function, valvular disease, pericardial effusion, and inferior vena cava size. Participating physicians received focused training and performed examinations either in response to clinical suspicion or as part of routine evaluation. The primary outcome was whether AI-guided FoCUS contributed to new diagnoses, treatment modifications, or additional procedures. Results: Artificial intelligence-enhanced FoCUS identified clinically relevant cardiac findings in 193 patients (29%), including newly recognized valvular abnormalities and reduced left ventricular function. In 49 patients (7%), medical therapy was adjusted based on findings, and 9 patients (1.4%) underwent interventional procedures. Diagnostic performance analyses showed high sensitivity for detecting reduced left ventricular function and valvular disease, with lower sensitivity for right-sided abnormalities. Conclusion: This study demonstrates that integrating AI-enhanced FoCUS into routine workflows can provide clinically relevant information that may influence diagnostic assessment and management by noncardiology practitioners in acute care settings.

  PublisherOA PDFDOI

• Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024

  Critical Care Medicine · 2025-02-01 · 26 citations

  article

  RATIONALE: Critical care ultrasonography (CCUS) is rapidly evolving with new evidence being published since the prior 2016 guideline. OBJECTIVES: To identify and assess the best evidence regarding the clinical outcomes associated with five CCUS applications in adult patients since the publication of the previous guidelines. PANEL DESIGN: An interprofessional, multidisciplinary, and diverse expert panel of 36 individuals including two patient/family representatives was assembled via an intentional approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including task force selection and voting. METHODS: Focused research questions based on Population, Intervention, Control, and Outcomes (PICO) for adult CCUS application were developed. Panelists applied the guidelines revision process described in the Standard Operating Procedures Manual to analyze supporting literature and to develop evidence-based recommendations as a focused update. The evidence was statistically summarized and assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The evidence-to-decision framework was used to formulate recommendations as strong or conditional. RESULTS: The Adult CCUS Focused Update Guidelines panel aimed to understand the current impact of CCUS on patient important outcomes as they related to five PICO questions in critically ill adults. A rigorous systematic review of evidence to date informed the panel's recommendations. In adult patients with septic shock, acute dyspnea/respiratory failure, or cardiogenic shock, we suggest using CCUS to guide management. Given evidence supporting an improvement in mortality, we suggest the use of CCUS for targeted volume management as opposed to usual care without CCUS. Last, there was insufficient data to determine if CCUS should be used over standard care without CCUS in the management of patients with cardiac arrest. CONCLUSIONS: The guidelines panel achieved strong agreement regarding the recommendations for CCUS to improve patient outcomes. These recommendations are intended for consideration along with the patient's existing clinical status.

  PublisherDOI

• Executive Summary: Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024

  Critical Care Medicine · 2025-02-01 · 1 citations

  article

  Critical care ultrasonography (CCUS) is point-of-care ultrasonography performed and interpreted by the treating clinician of critically ill patients, regardless of the hospital setting, to augment diagnosis, manage care, and guide invasive procedures (1). The role of CCUS as a diagnostic tool is well established, resulting in its rapid uptake throughout critical care medicine, where it is now commonly used at bedside. Despite the use of CCUS in everyday practice, we are uncertain of its effect on patient-important outcomes. This executive summary updates the previous guidelines on CCUS (2,3) by comparing clinical outcomes when using CCUS to those of usual care without CCUS in patients with cardiac arrest, septic shock, acute respiratory failure, volume management, and cardiogenic shock. The recommendations from these guidelines are the result of a diverse panel of experts systematically evaluating all available evidence to date (4–6). These recommendations assume that practitioners performing CCUS have appropriate equipment, training, and competency. These recommendations are meant to guide clinicians, although individual patient and practitioner characteristics must be factored into guideline implementation and should not solely replace a clinician’s judgment. For this focused update and systematic reviews, we developed five questions using the Population, Intervention, Control (Comparison), and Outcomes (PICO) framework. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is used to evaluate the certainty of evidence, and recommendations are made using the evidence-to-decision framework (7). The strength of each recommendation is designated as strong (signified by “we recommend”) or conditional (signified by “we suggest”). A summary of all recommendations is provided in Figure 1. In the executive summary below, we will highlight key recommendations from the PICO questions. A full description of the recommendations is provided in the complete guidelines document Additionally, Supplemental Contents 1-9 (http://links/lww.com/CCM/H630) can be accessed digitally for further clarificaiton.Figure 1.: Infographic summary of recommendations. CCUS = critical care ultrasonography, SCCM = Society of Critical Care Medicine.CCUS IN PATIENTS WITH SEPTIC SHOCK Recommendation We suggest using CCUS in the management of adults with septic shock to improve clinical outcomes (Conditional Recommendation, For; Low Quality of Evidence). Remark Although we observed a small benefit of mortality in patients with septic shock, it is possible that CCUS may offer more benefit in some patients compared with others. In septic patients where volume responsiveness is in question, there may be greater value in CCUS. Rationale Compared with usual care, CCUS may reduce mortality (low certainty), but there is little to no difference in the receipt of renal replacement therapy and ICU length of stay (both low certainty). Given the small reduction in mortality, the panel believes that the benefits of using CCUS likely outweigh the adverse effects. This is a weak recommendation, recognizing involvement of other factors such as resourcefulness to obtain ultrasound machines and proper training. Special Considerations The role of CCUS for guiding vasopressors and inotropes is not as clear, although CCUS can be useful in patients with underlying septic cardiomyopathy or those without a definitive characterization of shock. At present, there is no consensus on thresholds for initiating or titrating inotropes, vasopressors, or other adjunctive therapies in sepsis based on echocardiographic or ultrasound findings (8,9). The evidence indicates that the implementation of various CCUS modalities can effectively guide volume management in septic patients. CCUS IN PATIENTS WITH ACUTE DYSPNEA OR RESPIRATORY FAILURE Recommendation We suggest using CCUS to aid with diagnoses and to guide the management of adults with acute dyspnea or acute respiratory failure to improve clinical outcomes (Conditional Recommendation, For; Low Quality of Evidence). Remark The role of CCUS for diagnosis in patients with acute dyspnea or acute respiratory failure is viewed as a patient-relevant outcome because of the potential variations in etiology and the necessity for tailored therapies in such cases. In situations where the diagnosis is unequivocal, CCUS may not be as beneficial, although it still may offer other utility in ventilator management. Rationale The reduction in duration of mechanical ventilation, time to reach correct diagnosis and treatment, and the absence of increased adverse outcomes supports our suggestion to use CCUS in these patients, albeit with low certainty. CCUS may be more valuable in settings with limited access to conventional radiographic tests, such as during the COVID-19 pandemic or in resource-limited settings (10,11). In addition to diagnosis, CCUS can guide management of patients with acute dyspnea or respiratory failure, both with respect to diuresis and ventilator management (12,13). Special Considerations At present, it is unclear whether any specific CCUS protocol should be used. For example, CCUS was associated with shorter duration of mechanical ventilation when Salem et al (12) used lung ultrasound to titrate positive end-expiratory pressure compared with the Acute Respiratory Distress Syndrome Network standard protocol and demonstrated improved mortality and reduced duration of mechanical ventilation. Xia et al (14) assessed lung and diaphragm to gauge appropriateness for liberation from mechanical ventilation, while Pradhan et al (15) monitored patients with CCUS to evaluate for ventilator associated pneumonia. Studies in this area could help clarify and standardize approaches. CCUS FOR TARGETED VOLUME MANAGEMENT Recommendation We suggest the use of CCUS for targeted volume management compared with usual care without CCUS in acutely ill adult patients to improve clinical outcomes (Conditional Recommendation, For; Low Quality of Evidence). Rationale CCUS for targeted volume management may offer desirable effects with an observed decrease in mortality. This evidence is limited by indirectness, given both the varied designs and use of ultrasound by the individual studies. Although our systematic review finds that CCUS may reduce fluid balance, this should be interpreted contextually. With the publication of the CLASSIC and CLOVERS trials (16,17), it is evident that an isolated measure of fluid balance is not sufficient to make overarching conclusions. Some patients may benefit from more fluids and some from less (12,13). These findings, the lack of data to suggest that CCUS has undesirable effects, and the indirect evidence that a personalized approach to fluid management may be beneficial, informs our recommendation. Special Considerations CCUS is only one component of a multifaceted approach to determination of volume status. Much like clinical decision-making, CCUS is also prone to error, particularly in unskilled hands. The evidence shows that a variety of CCUS modalities can help target volume management. CCUS IN PATIENTS WITH CARDIOGENIC SHOCK Recommendation We suggest the use of CCUS compared with usual care without CCUS in adults with cardiogenic shock to improve clinical outcomes (Conditional Recommendation, For; Very Low Quality of Evidence). Remark Usual care in cardiogenic shock patients may include the use of a pulmonary artery catheter (PAC). CCUS can provide comparable information to that of a PAC, with the added advantages of portability, and superior safety profile. CCUS may provide further usefulness for certain patients who already have a PAC. Rationale Despite the lack of evidence showing a clear benefit of CCUS use for patients with cardiogenic shock, the panel made a conditional recommendation for its use due to the minimal adverse events with the use of CCUS and the undesirable effects of its alternatives (i.e., PAC). CCUS including transthoracic echocardiography (TTE) is noninvasive and more cost-effective when compared with PAC (18). CCUS involving transesophageal echocardiography (TEE) while invasive has overall low complication rates (19–23). In contrast, PACs can be associated with adverse events and data misinterpretation (24–26) but can be useful for cardiogenic shock patients receiving mechanical circulatory support or following heart transplantation (27–29). Considering these points, we suggest the use of CCUS over no use in patients with cardiogenic shock, including those who already have a PAC (30). Special Considerations CCUS is often used to diagnose cardiogenic shock and is routinely used in the management of these patients, despite lack of strong evidence supporting its use. It remains unclear whether patients receiving standard care were referred for consultative echocardiography (TTE or TEE performed by the echo laboratory team) during their treatment. These studies did not specifically compare CCUS and consultative echocardiography. Future studies comparing CCUS to PACs for the management of cardiogenic shock patients will be informative. CONCLUSIONS This focused guideline reviews the effect of CCUS vs. usual care without CCUS on patient-important outcomes. A few important areas where new CCUS data can guide best practices include: 1) randomized trials in septic shock using protocolized CCUS care for targeted volume management, 2) randomized trials comparing CCUS management and PAC management of cardiogenic shock, especially with practitioners appropriately trained in both modalities, and 3) the use of artificial intelligence to improve image acquisition, accuracy, and reproducibility of CCUS between users to improve clinical outcomes. An intentional research agenda for CCUS is paramount. ACKNOWLEDGMENTS The guidelines leadership would like to acknowledge Society of Critical Care Medicine staff, Hariyali Patel, and American College of Critical Care Medicine Board of Regents Dr. Lori Shutter, Dr. Karin Reuter-Rice, and Dr. Ana Lia Graciano for project management support throughout the guidelines-development process. Furthermore, we thank Kaitryn Campbell for developing the electronic search strategies, Karin Dearness for peer-review of search strategies, and Payal Jain, João Lima, Ali Moinuddin, Joshua Piticaru, Monica Sabbineni, Natasha Ovtcharenko, Irene Armanious, Jose Estrada-Codecido, Laiya Carayannopoulos, Holden Flindall, and Brian Tang for assisting with the systematic review.

  PublisherDOI

• Percutaneous Closure of Pulmonary Arteriovenous Malformation and Concomitant Patent Foramen Ovale for Cryptogenic Stroke

  ˜The œJournal of invasive cardiology/˜The œjournal of invasive cardiology · 2024-11-04

  article

  A 64-year-old woman presented with acute onset left-sided facial droop, left upper extremity paresis, and aphasia. Magnetic resonance imaging demonstrated acute infarction of the right thalamus. Clinical Images from Journal of Invasive Cardiology. cryptogenic stroke patent foramen ovale closure PFO Closure Pulmonary arteriovenous malformations

  PublisherDOI

• ASSOCIATION OF LEFT ATRIAL STRAIN WITH OUTCOMES IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

  Journal of the American College of Cardiology · 2024-04-01

  articleOpen accessSenior author
  PublisherDOI

• INTRADEVICE LEAK: A RARE BUT IMPORTANT COMPLICATION AFTER LEFT ATRIAL APPENDAGE OCCLUSION

  Journal of the American College of Cardiology · 2024-04-01

  articleSenior author
  PublisherDOI

• ASSOCIATION OF SPECKLE TRACKING ECHOCARDIOGRAPHY WITH ACUTE CELLULAR REJECTION IN CARDIAC TRANSPLANT PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

  Journal of the American College of Cardiology · 2024-04-01

  reviewSenior author
  PublisherDOI

• Utility of native T1 mapping and myocardial extracellular volume fraction in patients with nonischemic dilated cardiomyopathy: A systematic review and meta-analysis

  IJC Heart & Vasculature · 2024 · 8 citations

  Senior authorCorresponding
  • Medicine
  • Internal medicine
  • Cardiology

  Background: -analysis aims to characterize the utility of native T1 mapping and ECV in patients with non-ischemic cardiomyopathy (NICM) and to clarify the prognostic significance of elevated values. Methods: A literature search was conducted for studies reporting on use of CMR-based native T1 mapping and ECV measurement in NICM patients and their association with major adverse cardiac events (MACE), ventricular arrhythmias (VAs), and left ventricular reverse remodeling (LVRR). Databases searched included: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results: Native T1 and ECV were significantly higher in NICM patients compared to controls (MD 78.80, 95 % CI 50.00, 107.59; p < 0.01; MD 5.86, 95 % CI 4.55, 7.16; p < 0.01). NICM patients who experienced MACE had higher native T1 and ECV (MD 52.87, 95 % CI 26.59, 79.15; p < 0.01; MD 6.03, 95 % CI 3.79, 8.26; p < 0.01). There was a non-statistically significant trend toward higher native T1 time in NICM patients who experienced VAs. NICM patients who were poor treatment responders had higher baseline native T1 and ECV (MD 40.58, 95 % CI 12.90, 68.25; p < 0.01; MD 3.29, 95 % CI 2.25, 4.33; p < 0.01). Conclusions: CMR-based native T1 and ECV quantification may be useful tools for risk stratification of patients with NICM. They may provide additional diagnostic utility in combination with LGE, which poorly characterizes fibrosis in patients with diffuse myocardial involvement.

  PublisherDOI

• ACC/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2024 Appropriate Use Criteria for Multimodality Imaging in Cardiovascular Evaluation of Patients Undergoing Nonemergent, Noncardiac Surgery

  Journal of the American College of Cardiology · 2024-08-26 · 9 citations

  articleOpen access
  PublisherDOI

• Use of Speckle Tracking Echocardiography to Predict Right Heart Failure Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis

  Research Square · 2024-03-12

  reviewOpen accessSenior author

  Abstract Introduction Right Heart Failure (RHF) is an important consequence of implant of left ventricular assist devices (LVAD). Right ventricular (RV) analysis with speckle tracking echo (STE) can assist in the assessment of the RV. This meta-analysis examines preoperative RV strain on STE as a predictor of postoperative RHF. Methods Literature was reviewed in Pubmed, EMBASE, and Web of Science for studies reporting on the association of preoperative RV free wall (FWS), global longitudinal (GLS), and septal longitudinal (SLS) strain with postoperative RV failure following LVAD placement. Strain parameters were compared between the two groups. Results A total of 13 studies with 933 patients undergoing LVAD implantation met inclusion criteria. 254 patients subsequently developed RHF and 679 did not develop RHF. Mean follow up was 15 months. The mean age of participants was 55.9 years and 85% were male. Baseline RVFWS, RVGLS, and RVSLS were significantly reduced in patients who developed post-implantation RHF compared to patients who did not develop post-implantation RHF (MD 3.77, 95% CI 2.39, 5.15; p&lt;0.01; MD 2.67, 95% CI 1.16, 4.17; p&lt;0.01; MD 3.59, 95% CI 0.83, 6.35; p=0.01). The heterogeneity was considerable for all three analyses (RVFWS I2=88%, RVGLS I2=92%, RVSLS I2=83%), likely due to vendor-specific differences in strain measurements and differences in echocardiography lab protocols. To address this, a random-effects model was used. Conclusions Preoperative RV FWS, GLS, and SLS were all associated with postoperative RHF. STE may be helpful in risk stratification of RHF following LVAD implant.

  PublisherOA PDFDOI

Frequent coauthors

• John U. Doherty

  40 shared

• Puja B. Parikh

  37 shared

• Paul Schoenhagen

  Cleveland Clinic

  30 shared

• Hal A. Skopicki

  25 shared

• Nicole M. Bhave

  University of Michigan–Ann Arbor

  24 shared

• Gregory Dehmer

  23 shared

• Roxana Mehran

  Icahn School of Medicine at Mount Sinai

  18 shared

• Thomas V. Bilfinger

  Stony Brook Children's Hospital

  17 shared

Education

• M.D.

  Stony Brook University