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Effects Of Beta Blockers And Ace Inhibitors After Left Ventricular Assist Device Implantation, Gaurang Vaidya, Emma Birks, Jessica Pillarella, Benjamin Salgado, Rajakrishnan Vijayakrishnan, Andrew Lenneman, Mark Slaughter, Dmitry Abramov 2018 University of Louisville

Effects Of Beta Blockers And Ace Inhibitors After Left Ventricular Assist Device Implantation, Gaurang Vaidya, Emma Birks, Jessica Pillarella, Benjamin Salgado, Rajakrishnan Vijayakrishnan, Andrew Lenneman, Mark Slaughter, Dmitry Abramov

The VAD Journal

Purpose: While Beta blockers(BB) and Angiotensin system blockers(ACEinh/ARB) are important components in advanced heart failure therapy, their use after left ventricular assist device (LVAD) implantation remains controversial. Concern has been raised about possible adverse effects of BB on right ventricular(RV) function while tolerance and efficacy/outcome data for ACEinh are lacking. This study aimed to characterize the use of medical therapy post-LVAD implantation and to evaluate its safety and efficacy. Methods: Demographic, clinical and echocardiographic variables of patients implanted with a continuous-flow LVAD between 2012 and 2015 at a single center were retrospectively reviewed. Mortality and ...


The Epidemiology Of Infective Endocarditis Among People Who Inject Drugs In London, Ontario., Brian Hallam 2018 The University of Western Ontario

The Epidemiology Of Infective Endocarditis Among People Who Inject Drugs In London, Ontario., Brian Hallam

Electronic Thesis and Dissertation Repository

Infective endocarditis is an infectious disease that affects the valves of the heart. Injection drug use is currently a leading risk factor among patients with endocarditis. We conducted a prospective study using data from hospital chart records among patients with endocarditis in London, Ontario, which has a relatively high prevalence of people who inject drugs to assess the severity of the issue and the major risk factors of mortality pertaining to this population. This study had a sample size of 353 and included a review of the incidence of admissions of endocarditis, as well as a survival analysis, using both ...


Overcoming Small Data Limitations In Heart Disease Prediction By Using Surrogate Data, Alfeo Sabay, Laurie Harris, Vivek Bejugama, Karen Jaceldo-Siegl 2018 Southern Methodist University

Overcoming Small Data Limitations In Heart Disease Prediction By Using Surrogate Data, Alfeo Sabay, Laurie Harris, Vivek Bejugama, Karen Jaceldo-Siegl

SMU Data Science Review

In this paper, we present a heart disease prediction use case showing how synthetic data can be used to address privacy concerns and overcome constraints inherent in small medical research data sets. While advanced machine learning algorithms, such as neural networks models, can be implemented to improve prediction accuracy, these require very large data sets which are often not available in medical or clinical research. We examine the use of surrogate data sets comprised of synthetic observations for modeling heart disease prediction. We generate surrogate data, based on the characteristics of original observations, and compare prediction accuracy results achieved from ...


Heparin Bridging Therapy Is Not Necessary For Patients With Atrial Fibrillation Undergoing Temporary Interruption Of Warfarin Therapy For Elective Invasive Procedures Or Surgery, Shannon Paquette 2018 Wayne State University School of Medicine

Heparin Bridging Therapy Is Not Necessary For Patients With Atrial Fibrillation Undergoing Temporary Interruption Of Warfarin Therapy For Elective Invasive Procedures Or Surgery, Shannon Paquette

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. New Engl J Med. Aug 2015;373(9):823-833. doi: 10.1056/NEJMoa1501035


Predictors Of Patient Activation At Acs Hospital Discharge And Health Care Utilization In The Subsequent Year, Rebecca L. Kinney 2018 University of Massachusetts Medical School

Predictors Of Patient Activation At Acs Hospital Discharge And Health Care Utilization In The Subsequent Year, Rebecca L. Kinney

GSBS Dissertations and Theses

Background. AHA guidelines have been established to reduce Acute Coronary Syndrome (ACS)-related morbidity, mortality and recurrent events post-discharge. These recommendations emphasize the patient as an engaged member of the health care team in secondary prevention efforts. Patients with high levels of activation are more likely to perform activities that will promote their own health and are more likely to have their health care needs met. Despite evidence and strong expert consensus supporting patients as active collaborators in their own ACS care, the complexity and unexpected realities of self-managing one’s care at home are often underestimated. This study seeks ...


Electrocardiographic Characteristics, Antiarrhythmic Utilization, And Outcomes In Patients With Left Ventricular Assist Devices, Scott Lundgren, Elizabeth Lyden, Douglas Stoller, Marshall Hyden, Adam Burdorf, Ronald Zolty, John Um, Brian Lowes 2018 University of Nebraska Medical Center

Electrocardiographic Characteristics, Antiarrhythmic Utilization, And Outcomes In Patients With Left Ventricular Assist Devices, Scott Lundgren, Elizabeth Lyden, Douglas Stoller, Marshall Hyden, Adam Burdorf, Ronald Zolty, John Um, Brian Lowes

The VAD Journal

Background: Left ventricular assist devices (LVAD) are an increasingly used therapy for patients with advanced heart failure. Arrhythmias are common complications following LVAD implantation requiring admission, initiation, and escalation of medical therapy. Despite their frequent use in the treatment of arrhythmias, little has been reported regarding electrocardiographic changes, antiarrhythmic utilization, and outcomes post-LVAD.

Methods: A total of 309 patients who received a LVAD underwent retrospective chart review pre- and post-LVAD. Kaplan-Meier curves were calculated and compared using the log-rank test. Cox regression model was used for univariate analysis and those with a p

Results: There was a significant reduction in ...


Safety And Efficacy Of Routine Bridging Anticoagulation For Subtherapeutic Anticoagulation In Outpatients With A Left Ventricular Assist Device, David C. Shisler, Gaurang N. Vaidya, Lori Muncy, Rajakrishnan Vijayakrishnan, Mark S. Slaughter, Emma J. Birks, Dmitry Abramov 2018 University of Louisville

Safety And Efficacy Of Routine Bridging Anticoagulation For Subtherapeutic Anticoagulation In Outpatients With A Left Ventricular Assist Device, David C. Shisler, Gaurang N. Vaidya, Lori Muncy, Rajakrishnan Vijayakrishnan, Mark S. Slaughter, Emma J. Birks, Dmitry Abramov

The VAD Journal

Background

Anticoagulation with vitamin K antagonists is vital to prevent pump thrombosis in patients with left ventricular assist devices (LVADs). However, the safety and efficacy of bridging anticoagulation for the routine management of subtherapeutic international normalized ratio (INR) in stable outpatients remains poorly characterized.

Methods

In this retrospective study, a total of 60 LVAD outpatients had 110 episodes of subtherapeutic INR noted on routine testing. 34 of these episodes were managed with parenteral bridging anticoagulation and 76 were managed with only an adjusted dose of warfarin. The rates of bleeding and thromboembolic adverse events following these episodes of subtherapeutic INR ...


Role Of Echocardiography In The Intensive Care Unit: Overview Of The Most Common Clinical Scenarios, Luca Longobardo, Concetta Zito, Scipione Carerj, Giuseppe Caracciolo, Bijoy K. Khandheria 2018 University of Messina

Role Of Echocardiography In The Intensive Care Unit: Overview Of The Most Common Clinical Scenarios, Luca Longobardo, Concetta Zito, Scipione Carerj, Giuseppe Caracciolo, Bijoy K. Khandheria

Journal of Patient-Centered Research and Reviews

The intensive care unit (ICU) is among the more important settings in which echocardiography plays a pivotal role. The ease of use, speed of execution, and completeness of information on heart anatomy and function that echocardiography is able to provide makes this tool the perfect diagnostic technique in patients for whom exhaustive information must be quickly obtained by physicians who sometimes lack specific skills in cardiovascular imaging. However, the clinical entities encountered by ICU clinicians are often difficult to distinguish and patient symptoms may not be obvious. This brief review describes three common clinical scenarios that benefit from echocardiography in ...


Effect Of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database)., Chun Shing Kwok, Sara C Martinez, Samir Pancholy, Waqar Ahmed, Khaled Al-Shaibi, Jessica Potts, Mohamed Mohamed, Evangelos Kontopantelis, Nick Curzen, Mamas A Mamas 2018 Division of Cardiology, Providence St. Peter Hospital, Olympia, Washington

Effect Of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database)., Chun Shing Kwok, Sara C Martinez, Samir Pancholy, Waqar Ahmed, Khaled Al-Shaibi, Jessica Potts, Mohamed Mohamed, Evangelos Kontopantelis, Nick Curzen, Mamas A Mamas

All Publications

It is unclear how comorbidity influences rates and causes of unplanned readmissions following percutaneous coronary intervention (PCI). We analyzed patients in the Nationwide Readmission Database who were admitted to hospital between 2010 and 2014. The comorbidity burden as defined by the Charlson Comorbidity Index (CCI). Primary outcomes were 30-day readmission rates and causes of readmission according to comorbidity burden. A total of 2,294,346 PCI procedures were included the analysis. The patients in CCI = 0, 1, 2 and ≥3 were 842,272(36.7%), 701,476(30.6%), 347,537(15.1%) and 403,061(17.6%), respectively. 219 ...


Exploring The “Weekend Effect” On The Care Of Patients With Left Ventricular Assist Devices, Gbolahan O. Ogunbayo, Le Dung Ha, Naoki Misumida, Ayman Elbadawi, Qamar Ahmad, Remi Okwechime, Deborah Akanya, Andrew Kolodziej, Claude S. Elayi, Maya E. Guglin 2018 University of Kentucky

Exploring The “Weekend Effect” On The Care Of Patients With Left Ventricular Assist Devices, Gbolahan O. Ogunbayo, Le Dung Ha, Naoki Misumida, Ayman Elbadawi, Qamar Ahmad, Remi Okwechime, Deborah Akanya, Andrew Kolodziej, Claude S. Elayi, Maya E. Guglin

The VAD Journal

Many studies have described differences in in-hospital outcomes and length of stay between patients treated for major cardiac conditions on weekdays versus weekends.1 Our study aimed to explore the “weekend effect” on in-hospital care among patients with left ventricular assist devices.

Using data from the National Inpatient Sample (NIS) database, with a weighted estimate of more than 35 million admissions per year.2 We identified patients 18 years or older with an ICD code signifying presence of a LVAD. Characteristics, comorbidities and clinical outcomes were compared between patients admitted on a weekend versus patients admitted on a weekday. The ...


The Post Clinic Ambulatory Blood Pressure (Pc-Abp) Study Correlates Post Clinic Blood Pressure (Pcbp) With The Gold Standard Ambulatory Blood Pressure, Hunaina Shahab, Hamza Sohail Khan, Aysha Almas, Mayera Tufail, K. Kazmi, Aamir Hameed 2018 Aga Khan University

The Post Clinic Ambulatory Blood Pressure (Pc-Abp) Study Correlates Post Clinic Blood Pressure (Pcbp) With The Gold Standard Ambulatory Blood Pressure, Hunaina Shahab, Hamza Sohail Khan, Aysha Almas, Mayera Tufail, K. Kazmi, Aamir Hameed

Section of Cardiology

Objectives: Our previous study showed that post-clinic blood pressure (BP) taken 15 min after a physician-patient encounter was the lowest reading in a routine clinic. We aimed to validate this reading with 24 h Ambulatory Blood Pressure Monitoring (ABPM) readings. A cross-sectional study was conducted in the cardiology clinics at the Aga Khan University, Pakistan. Hypertensive patients aged ≥ 18 years, or those referred for the diagnosis of hypertension were included.

Results: Of 150 participants, 49% were males. 76% of all participants were hypertensive. Pre-clinic BP reading was measured by a nurse, in-clinic by a physician and 15 min post-clinic by ...


Aspirin In Primary Prevention Of Myocardial Infarction/Angina And Stroke In Hypertensive Patients, Aysha Almas, Muhammad Salman Ghazni, Shahrukh Hashman, Zain Mushtaq 2018 Aga Khan University

Aspirin In Primary Prevention Of Myocardial Infarction/Angina And Stroke In Hypertensive Patients, Aysha Almas, Muhammad Salman Ghazni, Shahrukh Hashman, Zain Mushtaq

Section of Internal Medicine

No abstract provided.


Cardiac-Derived Ctrp9 Protects Against Myocardial Ischemia/Reperfusion Injury Via Calreticulin-Dependent Inhibition Of Apoptosis., Dajun Zhao, Pan Feng, Yang Sun, Zhigang Qin, Zhengbin Zhang, Yanzhen Tan, Erhe Gao, Wayne Bond Lau, Xin-Liang Ma, Jian Yang, Shiqiang Yu, Xuezeng Xu, Dinghua Yi, Wei Yi 2018 Fourth Military Medical University (China)

Cardiac-Derived Ctrp9 Protects Against Myocardial Ischemia/Reperfusion Injury Via Calreticulin-Dependent Inhibition Of Apoptosis., Dajun Zhao, Pan Feng, Yang Sun, Zhigang Qin, Zhengbin Zhang, Yanzhen Tan, Erhe Gao, Wayne Bond Lau, Xin-Liang Ma, Jian Yang, Shiqiang Yu, Xuezeng Xu, Dinghua Yi, Wei Yi

Department of Emergency Medicine Faculty Papers

Cardiokines play an essential role in maintaining normal cardiac functions and responding to acute myocardial injury. Studies have demonstrated the heart itself is a significant source of C1q/TNF-related protein 9 (CTRP9). However, the biological role of cardiac-derived CTRP9 remains unclear. We hypothesize cardiac-derived CTRP9 responds to acute myocardial ischemia/reperfusion (MI/R) injury as a cardiokine. We explored the role of cardiac-derived CTRP9 in MI/R injury via genetic manipulation and a CTRP9-knockout (CTRP9-KO) animal model. Inhibition of cardiac CTRP9 exacerbated, whereas its overexpression ameliorated, left ventricular dysfunction and myocardial apoptosis. Endothelial CTRP9 expression was unchanged while cardiomyocyte CTRP9 ...


Indexed Left Atrial Adipose Tissue Area Is Associated With Severity Of Atrial Fibrillation And Atrial Fibrillation Recurrence Among Patients Undergoing Catheter Ablation, Saket R. Sanghai, Mayank Sardana, Barinder Hansra, Darleen M. Lessard, Seth T. Dahlberg, Gerard P. Aurigemma, Timothy P. Fitzgibbons, David D. McManus 2018 University of Massachusetts Medical School

Indexed Left Atrial Adipose Tissue Area Is Associated With Severity Of Atrial Fibrillation And Atrial Fibrillation Recurrence Among Patients Undergoing Catheter Ablation, Saket R. Sanghai, Mayank Sardana, Barinder Hansra, Darleen M. Lessard, Seth T. Dahlberg, Gerard P. Aurigemma, Timothy P. Fitzgibbons, David D. Mcmanus

Open Access Articles

Background: Epicardial adipose tissue (EAT) has been associated with adverse left atrial (LA) remodeling and atrial fibrillation (AF) outcomes, possibly because of paracrine signaling.

Objectives: We examined factors associated with a novel measure of EAT i.e., indexed LAEAT (iLAEAT) and its prognostic significance after catheter ablation (CA) of atrial fibrillation (AF).

Methods: We performed a retrospective analysis of 274 participants with AF referred for CA. LAEAT area was measured from a single pre-ablation CT image and indexed to body surface area (BSA) to calculate iLAEAT. Clinical, echocardiographic data and 1-year AF recurrence rates after CA were compared across tertiles ...


Reversal Of Fixed Pulmonary Hypertension With Transcatheter Valve Replacement For Aortic Insufficiency On Ventricular Assist Device Support, Faraz S. Ahmad, Mark J. Ricciardi, Laura J. Davidson, Allen S. Anderson, Kambiz Ghafourian, Ike Okwuosa, Esther Vorovich, Jane E. Wilcox, Daniel D. Holloway, Duc T. Pham, Jonathan D. Rich 2018 Northwestern University

Reversal Of Fixed Pulmonary Hypertension With Transcatheter Valve Replacement For Aortic Insufficiency On Ventricular Assist Device Support, Faraz S. Ahmad, Mark J. Ricciardi, Laura J. Davidson, Allen S. Anderson, Kambiz Ghafourian, Ike Okwuosa, Esther Vorovich, Jane E. Wilcox, Daniel D. Holloway, Duc T. Pham, Jonathan D. Rich

The VAD Journal

We present a 43-year-old woman with a nonischemic cardiomyopathy implanted with a ventricular assist device (VAD) as bridge to transplant due to severe, “fixed” pulmonary hypertension (PH). Within three months of VAD implant, her “fixed” PH had resolved entirely. Nearly two years later, still supported with a VAD because of severe HLA allosensitization, she developed dyspnea and “moderate” aortic insufficiency (AI) by standard criteria. Invasive hemodynamics revealed recurrence of severe PH in the setting of elevated left-sided filling pressures. We concluded the AI was indeed severe and the cause of her symptoms and recurrent PH. Despite her minimally calcified aortic ...


Letter To The Editor: Management Of Pfo: More Evidence, Same Recommendation, Halima Ali, MD 2018 Beaumont Wayne Family Medicine Residency

Letter To The Editor: Management Of Pfo: More Evidence, Same Recommendation, Halima Ali, Md

Clinical Research in Practice: The Journal of Team Hippocrates

The author offers more evidence to support Zhang's assertion in CRP 3(2) that closure of patent foramen ovale or medical therapy alone are both appropriate choices for preventing recurrent cryptogenic strokes (https://doi.org/10.22237/crp/1518739380).


Amniotic Fluid Embolism, Nadia Nawaz, Ahmed Raheem Buksh 2018 Aga Khan University

Amniotic Fluid Embolism, Nadia Nawaz, Ahmed Raheem Buksh

Department of Obstetrics & Gynaecology

Amniotic fluid embolism is a rare and severe problem in obstetric patients. We experienced a 21-year primigravida who underwent emergency cesarean section due to sudden collapse and fetal distress after rupture of membranes in labour. Subsequently, she developed intraoperative coagulopathy, hemorrhage, hypotension, and respiratory collapse requiring ventilation. Both maternal and neonatal lives were saved with full recovery and discharged in stable condition. The clinical diagnosis of amniotic fluid embolism (AFE) was made, which is a very rare complication of pregnancy/puerperium with varying presentation, ranging from cardiac arrest, circulatory collapse and death through mild degrees of organ system dysfunction with ...


Plasma Circulating Extracellular Rnas In Left Ventricular Remodeling Post-Myocardial Infarction, Kirsty M. Danielson, Kahraman Tanriverdi, Jane E. Freedman, Saumya Das 2018 Harvard Medical School

Plasma Circulating Extracellular Rnas In Left Ventricular Remodeling Post-Myocardial Infarction, Kirsty M. Danielson, Kahraman Tanriverdi, Jane E. Freedman, Saumya Das

Open Access Articles

Despite substantial declines in mortality following myocardial infarction (MI), subsequent left ventricular remodeling (LVRm) remains a significant long-term complication. Extracellular small non-coding RNAs (exRNAs) have been associated with cardiac inflammation and fibrosis and we hypothesized that they are associated with post-MI LVRm phenotypes. RNA sequencing of exRNAs was performed on plasma samples from patients with "beneficial" (decrease LVESVI > /=20%, n=11) and "adverse" (increase LVESVI > /=15%, n=11) LVRm. Selected differentially expressed exRNAs were validated by RT-qPCR (n=331) and analyzed for their association with LVRm determined by cardiac MRI. Principal components of exRNAs were associated with LVRm phenotypes post-MI ...


Study Of Early After Depolarization In A Complex Human Cardiac Cell Model In Tissue, Abouzar Kaboudian, Yanyan Claire Ji, Elizabeth M. Cherry, Flavio H. Fenton 2018 Georgia Institute of Technology

Study Of Early After Depolarization In A Complex Human Cardiac Cell Model In Tissue, Abouzar Kaboudian, Yanyan Claire Ji, Elizabeth M. Cherry, Flavio H. Fenton

Biology and Medicine Through Mathematics Conference

No abstract provided.


Efficacy And Safety Of Direct Oral Anticoagulants Approved For Cardiovascular Indications: Systematic Review And Meta-Analysis, Raghavendra Charan Makam, David C. Hoaglin, David D. McManus, Victoria Wang, Joel M. Gore, Frederick A. Spencer, Richeek Pradhan, Hoang Tran, Hong Yu, Robert J. Goldberg 2018 University of Massachusetts Medical School

Efficacy And Safety Of Direct Oral Anticoagulants Approved For Cardiovascular Indications: Systematic Review And Meta-Analysis, Raghavendra Charan Makam, David C. Hoaglin, David D. Mcmanus, Victoria Wang, Joel M. Gore, Frederick A. Spencer, Richeek Pradhan, Hoang Tran, Hong Yu, Robert J. Goldberg

Quantitative Health Sciences Publications and Presentations

BACKGROUND: Direct oral anticoagulants (DOACs) have emerged as promising alternatives to vitamin K antagonists (VKAs) for patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). Few meta-analyses have included all DOACs that have received FDA approval for these cardiovascular indications, and their overall comparisons against VKAs have shortcomings in data and methods. We provide an updated overall assessment of the efficacy and safety of those DOACs at dosages currently approved for NVAF or VTE, in comparison with VKAs.

METHODS: We used data from Phase 3 randomized trials that compared an FDA-approved DOAC with VKA for primary prevention of stroke ...


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