Medicine and Health Sciences Commons^™

When Is Door-To-Balloon Time Critical? Analysis From The Horizons-Ami (Harmonizing Outcomes With Revascularization And Stents In Acute Myocardial Infarction) And Cadillac (Controlled Abciximab And Device Investigation To Lower Late Angioplasty Complications) Trials, Bruce R. Brodie Md, Bernard J. Gersh Mb, Chb, Dphil, Thomas D. Stuckey Md, Bernhard Witzenbichler Md, Giulio Guagliumi Md, Jan Z. Peruga Md, Dariusz Dudek Md, Cindy L. Grines Md, David A. Cox Md, Helen Parise Scd, Abhiram Prasad Md, Alexandra J. Lansky Md, Roxana Mehran Md, Gregg W. Stone Md

Department of Medicine

No abstract provided.

Body Mass Index, Treatment Practices, And Mortality In Patients With Acute Heart Failure, Timothy Fitzgibbons, Olga Hardy, Darleen Lessard, Joel Gore, Jorge Yarzebski, Robert Goldberg

Jorge L. Yarzebski

OBJECTIVES: Obesity is associated with an increased risk of heart failure (HF). Among patients presenting with acute HF, however, differences in clinical characteristics, treatment regimens, and short-term prognosis of varying weights are largely unknown, particularly from a broader population-based perspective. METHODS: A total of 3722 patients admitted with acute HF to 11 greater Worcester (Massachusetts, USA) hospitals during 1995 and 2000 were categorized as being lean (n = 216), normal weight (n = 1465), overweight (n = 1007), or obese (n = 1034) at the time of hospitalization. RESULTS: Obese patients with decompensated HF were significantly younger (mean age = …

Use Of Lipid-Lowering Medication In Patients With Acute Myocardial Infarction (Worcester Heart Attack Study), Robert Goldberg, Ira Ockene, Jorge Yarzebski, Judith Savageau, Joel Gore

Jorge L. Yarzebski

As part of a population-based longitudinal study, we examined the use of lipid-lowering medication in 3,824 patients hospitalized with acute myocardial infarction in the Worcester, Massachusetts metropolitan area between 1986 and 1993. The rate of utilization of lipid-lowering medication either before (1.8%) or during hospitalization (1.9%) for acute myocardial infarction was low.

Validation Of A Stroke Symptom Questionnaire For Epidemiological Surveys., Paulo A. Lotufo

Paulo A Lotufo

CONTEXT AND OBJECTIVE:Stroke is a relevant issue within public health and requires epidemiological surveillance tools. The aim here was to validate a questionnaire for evaluating individuals with stroke symptoms in the Stroke Morbidity and Mortality Study (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral, EMMA), São Paulo, Brazil.DESIGN AND SETTING:This was a cross-sectional study performed among a sample of the inhabitants of Butantã, an area in the western zone of the city of São Paulo.METHODS:For all households in the coverage area of a primary healthcare unit, household members over the age of 35 years answered a stroke symptom questionnaire …

Gsk-3alpha Directly Regulates Beta-Adrenergic Signaling And The Response Of The Heart To Hemodynamic Stress In Mice., Jibin Zhou, Hind Lal, Xiongwen Chen, Xiying Shang, Jianliang Song, Yingxin Li, Risto Kerkela, Bradley W Doble, Katrina Macaulay, Morgan Decaul, Walter J Koch, John Farber, James Woodgett, Erhe Gao, Thomas Force

Center for Translational Medicine Faculty Papers

The glycogen synthase kinase-3 (GSK-3) family of serine/threonine kinases consists of 2 highly related isoforms, alpha and beta. Although GSK-3beta has an important role in cardiac development, much remains unknown about the function of either GSK-3 isoform in the postnatal heart. Herein, we present what we believe to be the first studies defining the role of GSK-3alpha in the mouse heart using gene targeting. Gsk3a(-/-) mice over 2 months of age developed progressive cardiomyocyte and cardiac hypertrophy and contractile dysfunction. Following thoracic aortic constriction in young mice, we observed enhanced hypertrophy that rapidly transitioned to ventricular dilatation and contractile dysfunction. …

Outcomes After Implantation Of The Taxus Paclitaxel-Eluting Stent In Saphenous Vein Graft Lesions: Results From The Arrive (Taxus Peri-Approval Registry: A Multicenter Safety Surveillance) Program, Emmanouil S. Brilakis Md, Phd, John M. Lasala Md, Phd, David A. Cox Md, Peter B. Berger Md, Thomas S. Bowman Md, Mph, Ruth M. Starzyk Phd, Keith D. Dawkins Md

Department of Medicine

No abstract provided.

Circadian Rhythms In Patients With St-Elevation Myocardial Infarction, Richard Aplin Md, Dr Holmes Md, Fv Acquirre

Articles

BACKGROUND:

Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle.

METHODS AND RESULTS:

The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was …

Clopidogrel Hypersensitivity: Clinical Challenges And Options For Management., Kimberly L Campbell, John R Cohn, Michael P Savage

Division of Cardiology Faculty Papers

Over 90 million patients have been prescribed clopidogrel since its US FDA approval in 1997. Clopidogrel hypersensitivity affects up to 6% of patients, most commonly in the form of a pruritic rash. Symptoms are severe enough to result in drug discontinuation in 1.5% of patients. Premature discontinuation of clopidogrel is problematic following percutaneous coronary intervention because of the risk of stent thrombosis leading to myocardial infarction and death. Accordingly, the management of patients with clopidogrel hypersensitivity is of significant clinical importance. Conventional clopidogrel desensitization protocols, while successful in most patients, employ a washout period off medication to enable accurate detection …

Letter By Harris Et Al Regarding Article, "Outcomes Of Patients With Acute Type A Aortic Intramural Hematoma, Jamie M. Pelzel

Articles

We read with interest the report by Song et al1 outlining the management of ascending aortic intramural hematoma (IMH) at the Asan Medical Center in Seoul, South Korea. This series, the largest of this life-threatening condition, demonstrated that at that institution, 84% of patients (n=85) could be treated with initial medical therapy, resulting in a mortality rate of 7.1%. These results are impressive but are observational rather than a randomized comparison of medical and surgical therapy.

Socioeconomic Status And Coronary Heart Disease Mortality In The City Of Sao Paulo, Brazil (1996 To 2007), Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Initial Experience With A Miniaturized Multiplane Transesophageal Probe In Small Infants Undergoing Cardiac Operations., Sinai C. Zyblewski, Girish S. Shirali, Geoffrey A. Forbus, Tain-Yen Hsia, Scott M. Bradley, Andrew M. Atz, Meryl S. Cohen, Eric M. Graham

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: There has been reluctance to use intraoperative transesophageal echocardiography (TEE) in small infants. We assessed the utility and safety of a new miniaturized multiplane micro-TEE probe in small infants undergoing cardiac operations.

DESCRIPTION: Hemodynamic and ventilation variables were prospectively recorded before and after micro-TEE insertion and removal in infants weighing 5 kg or less undergoing cardiac operations.

EVALUATION: The study included 42 patients with a mean weight of 3.6 +/- 0.9 kg (range, 1.7 to 5 kg). All probe insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation variables. Information provided by TEE …

Poor Childhood Dental Care: A Risk Factor For The Development Of Coronary Artery Disease And Potential New Target For Cad Prevention, Martin E. Matsumura Md, Taylor Trapp, Shameer Ahmed

Department of Medicine

No abstract provided.

Non-Inferiority Trials [In Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Cardiovascular And Cancer Mortality In Brazil, Paulo A. Lotufo

Paulo A Lotufo

Cancer are not surpassing Cardiovascular Diseases. Here you have an evaluation of mortality in Brazil. The debate was ignited by paper from IARC (International Agency for Research on Cancer) that forecasts cancer deaths surpassing heart diseases rates during de 2020’s. There is no dispute about the fact that - at least in the US and other countries - the decline of mortality deaths for heart diseases presenting a faster pace compared to cancer death rates. It is an epidemiological evidence that must be analyzed and some headline fueling hype as “heart diseases as an old agenda of public health and …

Inadvertent Respiratory Acidosis Due To Damaged Water Trap Of Capnograph By Isoflurane, Eileen R. Manabat, Md, Richard Berman, Md, Yoogoo Kang, Md

Department of Anesthesiology Faculty Papers

Introduction: A few reports have documented isoflurane leakage causing damage to the water trap in the Drager Apollo anesthesia machine. This case describes an abnormal capnograph tracing yielding falsely normal end-tidal carbon dioxide tension (EtCO2) after breakage of the water trap by isoflurane.

Cocaine And The Heart., Suraj Maraj, Vincent M. Figueredo, M.D., D Lynn Morris

Division of Cardiology Faculty Papers

The use of cocaine may be associated with either acute or chronic toxicity, and approximately 5% to 10% of emergency department visits in the United States are believed to be secondary to cocaine usage. Chest pain is the most common cocaine-related medical problem, leading to the evaluation of approximately 64,000 patients annually for possible myocardial infarction, of which approximately 57% are admitted to the hospital, resulting in an annual cost greater than $83 million. There is a plethora of cocaine-related cardiovascular complications, including acute myocardial ischemia and infarction, arrhythmias, sudden death, myocarditis, cardiomyopathy, hypertension, aortic ruptures, and endocarditis. There is …

Increase In Organization Index Predicts Atrial Fibrillation Termination With Flecainide Post-Ablation: Spectral Analysis Of Intracardiac Electrograms, Jiun Tuan, Faizel Osman, Jeilan Mohamed, Suman Kundu, Rajkumar Mantravadi, Peter J. Stafford, G. André Ng

Internal Medicine, East Africa

Aims: The mechanism of the action of flecainide in the termination of human atrial fibrillation (AF) is not fully understood. We studied the acute effects of flecainide on AF electrograms in the time and frequency domain to identify factors associated with AF termination.

Methods and results: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. Dominant frequency (DF) and organization index (OI) were obtained by fast Fourier transform of electrograms from the coronary sinus catheter over 10 s in AF, before and after flecainide infusion. Mean AF cycle length (CL) was …

Percutaneous Coronary Intervention In Unprotected Left Main Coronary Artery Disease, Hafeez Ahmed, Javed Majid Tai, Sajid H. Dhakam

Section of Cardiology

Percutaneous coronary intervention for unprotected left main coronary artery disease is potentially an important intervention in surgically unstable patients. A detailed review of medical record and visual analysis of coronary angiography and PCI procedure was undertaken. The study was conducted at the Aga Khan University Hospital, from January 2003 to December 2007. Patients included in the study had unprotected > 70% left main stenosis with ongoing ischemia, considered unsuitable for surgical revascularization. A total of 9 patients were included with a mean age of 70.1 years. Six patients had cardiogenic shock. Eight patients had bifurcation lesion. Simultaneous kissing stenting technique was …

Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation With The Medtronic-Corevalve Bioprosthesis, Hasan Jilaihawi, Derek Chin, Tomasz Spyt, Jeilan Mohamed, Mariuca Vasa-Nicotera, Johan Bence, Elaine Logtens, Jan Kovac

Internal Medicine, East Africa

Aims: Prosthesis-patient mismatch (P-PM) is an important determinant of morbidity and mortality following open aortic valve replacement. The aims of this study were to report its incidence and determinants following transcatheter aortic valve implantation (TAVI) with the Corevalve bioprosthesis, which have—thus far—not been described.

Methods and results: Patients with severe calcific aortic stenosis received TAVI with the Corevalve bioprosthesis via transfemoral route. Following TAVI, moderate P-PM was defined as indexed aortic valve effective orifice area (AVAi) ≤0.85 cm2/m2 and severe P-PM as AVAi ≤0.65 cm2/m2. Clinical, echocardiographic, and procedural factors relating to P-PM were studied. Optimal device position was defined …

Alcohol And Arrhythmias: A Comprehensive Review., Anil George, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

The use of alcohol as a social lubricant has been ubiquitous in human societies since ancient times. It has also long been recognized that alcohol produces undesirable cardiovascular effects, especially when imbibed in excess. Numerous investigators have noted a causal relationship between alcohol and arrhythmias, as well as sudden cardiac death. We have undertaken a comprehensive review of the literature on alcohol as a potential trigger for arrhythmias. We have reviewed the major epidemiological studies undertaken on this subject. We have also explored pathophysiological mechanisms that drive the arrythmogenic effects of alcohol. In conclusion, although there is definite proof in …

Impact Of Delay To Angioplasty In Patients With Acute Coronary Syndromes Undergoing Invasive Management : Analysis From The Acuity (Acute Catheterization And Urgent Intervention Triage Strategy) Trial, Paul Sorajja Md, Bernard J. Gersh Mb, Chb, Dphil, David A. Cox Md, Michael G. Mclaughlin Md, Peter Zimetbaum Md, Costantino Constantini Md, Thomas D. Stuckey Md, James E. Tcheng Md, Roxana Mehran Md, Alexandra J. Lansky Md, Cindy L. Grines Md, Gregg W. Stone Md

Department of Medicine

No abstract provided.

Trpm7-Mediated Ca2+ Signals Confer Fibrogenesis In Human Atrial Fibrillation, Jianyang Du, Jia Xie, Zheng Zhang, Hiroto Tsujikawa, Daniel Fusco, David Silverman, Bruce Liang, Lixia Yue

UCHC Articles - Research

Rationale—Cardiac fibrosis contributes to pathogenesis of atrial fibrillation (AF), which is the most sustained arrhythmia and a major cause of morbidity and mortality. Although it has been suggested that Ca2+ signals are involved in fibrosis promotion, the molecular basis of Ca2+ signaling mechanisms and how Ca2+ signals contribute to fibrogenesis remain unknown.
Objective—To determine the molecular mechanisms of Ca2+-permeable channel(s) in human atrial fibroblasts, and to investigate how Ca2+ signals contribute to fibrogenesis in human AF.
Methods and Results—We demonstrate that the transient receptor potential melastatin related 7 (TRPM7) is the molecular basis of the major Ca2+-permeable channel in human …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

The Utility Of Modified Butler-Leggett Criteria For Right Ventricular Hypertrophy In Detection Of Clinically Significant Shunt Ratio In Ostium Secundum-Type Atrial Septal Defect In Adults, Adeel M. Siddiqui, Zainab Samad, Nina Hakacova, James Kinsella, Cary Ward, Michael White, Anna Lisa C. Crowley, Galen S. Wagner, J. Kevin Harrison

Section of Cardiology

Background: This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs).

Methods: Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis.

Results: The mean Qp/Qs ratio and BL criterion value were 1.61 +/- 0.46 and 0.11 +/- 0.41, respectively. The BL criterion values correlated with shunt ratios (r(2) = …

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction, Hafeez Ahmed, Javed Majid Tai, Sohail Abrar Khan, Muniza Yousuf

Section of Cardiology

OBJECTIVE: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.

STUDY DESIGN: A cross-sectional study.

PLACE AND DURATION OF STUDY: The Aga Khan University, Karachi, from June to September 2007.

METHODOLOGY: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer's exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.

RESULTS: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference (p=0.045) …

Cardioprotection By Regular Ethanol Consumption: Potential Mechanisms And Clinical Application., Masami Miyamae, Kazuhiro Kaneda, Naochika Domae, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Epidemiological studies demonstrate that excessive drinking is associated with hypertension, cerebral bleeding and loss of cardiac contractility. Conversely, studies have shown that mortality rates for people who regularly drink ethanol in moderation are lower than in abstainers, primarily due to decreased fatal ischemic heart disease. Further, moderate ethanol consumers have lower rates of myocardial infarction compared with abstainers. These beneficial cardiac effects may be due to pleiotropic effects of ethanol on lipids, platelets, and fibrinolytic activity. During the past decade, studies conducted in several animal models have revealed that light to moderate regular ethanol consumption renders hearts more tolerant to …

Gender Differences Of Case-Fatality Rate In A Brazilian Stroke Registry, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Characteristics Of Small Areas With A Higher Stroke Mortality, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Higher Frequency Of Stroke Deaths On Monday And Saturday, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Social Inequalities And The Decline Of Stroke Mortality In The City Of Sao Paulo, Brazil, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.