Medicine and Health Sciences Commons^™

Utilizing The Stop-Bang Questionnaire To Assess Risk Of Obstructive Sleep Apnea In Hospitalized Patients With Heart Failure To Facilitate Sleep Medicine Referrals Upon Discharge, Chelsea Mitchell

DNP Projects

Background: Obstructive sleep apnea (OSA) is the most common sleep-breathing disorder. Undiagnosed OSA is highly prevalent in the population, especially in those with heart failure. OSA and heart failure combined create a negative feedback loop that can lead to poor clinical outcomes. Unfortunately, many cardiac patients are never screened for OSA.

Purpose: The purpose of this project is to improve screening rates for OSA via the STOP-Bang questionnaire and establish an efficient and effective process for referrals to sleep medicine for heart failure patients screening high-risk.

Methods: The design was a quality improvement project with pre- and post-testing and a …

Cardiac Cell Therapy: Insights Into The Mechanisms Of Tissue Repair, Hsuan Peng, Kazuhiro Shindo, Renée R. Donahue, Ahmed K. Abdel-Latif

Gill Heart & Vascular Institute Faculty Publications

Stem cell-based cardiac therapies have been extensively studied in recent years. However, the efficacy of cell delivery, engraftment, and differentiation post-transplant remain continuous challenges and represent opportunities to further refine our current strategies. Despite limited long-term cardiac retention, stem cell treatment leads to sustained cardiac benefit following myocardial infarction (MI). This review summarizes the current knowledge on stem cell based cardiac immunomodulation by highlighting the cellular and molecular mechanisms of different immune responses to mesenchymal stem cells (MSCs) and their secretory factors. This review also addresses the clinical evidence in the field.

Liposomal Delivery Of Azithromycin Enhances Its Immunotherapeutic Efficacy And Reduces Toxicity In Myocardial Infarction, Ahmed Al-Darraji, Renée R. Donahue, Himi Tripathi, Hsuan Peng, Bryana M. Levitan, Lakshman Chelvarajan, Dalia Haydar, Erhe Gao, David Henson, John C. Gensel, David J. Feola, Vincent J. Venditto, Ahmed K. Abdel-Latif

Gill Heart & Vascular Institute Faculty Publications

A growing body of evidence shows that altering the inflammatory response by alternative macrophage polarization is protective against complications related to acute myocardial infarction (MI). We have previously shown that oral azithromycin (AZM), initiated prior to MI, reduces inflammation and its negative sequelae on the myocardium. Here, we investigated the immunomodulatory role of a liposomal AZM formulation (L-AZM) in a clinically relevant model to enhance its therapeutic potency and avoid off-target effects. L-AZM (40 or 10 mg/kg, IV) was administered immediately post-MI and compared to free AZM (F-AZM). L-AZM reduced cardiac toxicity and associated mortality by 50% in mice. We …

Sod2 Deficiency In Cardiomyocytes Defines Defective Mitochondrial Bioenergetics As A Cause Of Lethal Dilated Cardiomyopathy, Sudha Sharma, Susmita Bhattarai, Hosne Ara, Grace Sun, Daret K. St. Clair, Md Shenuarin Bhuiyan, Christopher Kevil, Megan N. Watts, Paari Dominic, Takahiko Shimizu, Kevin J. Mccarthy, Hong Sun, Manikandan Panchatcharam, Sumitra Miriyala

Toxicology and Cancer Biology Faculty Publications

Electrophilic aldehyde (4-hydroxynonenal; 4-HNE), formed after lipid peroxidation, is a mediator of mitochondrial dysfunction and implicated in both the pathogenesis and the progression of cardiovascular disease. Manganese superoxide dismutase (MnSOD), a nuclear-encoded antioxidant enzyme, catalyzes the dismutation of superoxide radicals (O2^•-) in mitochondria. To study the role of MnSOD in the myocardium, we generated a cardiomyocyte-specific SOD2 (SOD2Δ) deficient mouse strain. Unlike global SOD2 knockout mice, SOD2Δ mice reached adolescence; however, they die at ~4 months of age due to heart failure. Ultrastructural analysis of SOD2Δ hearts revealed altered mitochondrial architecture, with prominent disruption of the …

Heart Failure In Humans Reduces Contractile Force In Myocardium From Both Ventricles, Cheavar A. Blair, Elizabeth A Brundage, Katherine L. Thompson, Arnold J. Stromberg, Maya Guglin, Brandon J Biesiadecki, Kenneth S. Campbell

Statistics Faculty Publications

This study measured how heart failure affects the contractile properties of the human myocardium from the left and right ventricles. The data showed that maximum force and maximum power were reduced by approximately 30% in multicellular preparations from both ventricles, possibly because of ventricular remodeling (e.g., cellular disarray and/or excess fibrosis). Heart failure increased the calcium (Ca²⁺) sensitivity of contraction in both ventricles, but the effect was bigger in right ventricular samples. The changes in Ca²⁺ sensitivity were associated with ventricle-specific changes in the phosphorylation of troponin I, which indicated that adrenergic stimulation might induce different effects …

Regulation Of Myofilament Contractile Function In Human Donor And Failing Hearts, Kerry S. Mcdonald, Laurin M. Hanft, Joel C. Robinett, Maya Guglin, Kenneth S. Campbell

Internal Medicine Faculty Publications

Heart failure (HF) often includes changes in myocardial contractile function. This study addressed the myofibrillar basis for contractile dysfunction in failing human myocardium. Regulation of contractile properties was measured in cardiac myocyte preparations isolated from frozen, left ventricular mid-wall biopsies of donor (n = 7) and failing human hearts (n = 8). Permeabilized cardiac myocyte preparations were attached between a force transducer and a position motor, and both the Ca²⁺ dependence and sarcomere length (SL) dependence of force, rate of force, loaded shortening, and power output were measured at 15 ± 1°C. The myocyte preparation size was …

The Use Of Cardiomems In Dialysis Patients With Heart Failure, Karolina Viquez, Peggy Hardesty, Karim Fahmy, Amr Elhusseini, Mohamed Elyamny, Maya Guglin

The VAD Journal

In patients with chronic kidney disease (CKD) and heart failure (HF), volume overload is a major problem. Removal of fluid during the dialysis treatment, is the cornerstone management in these conditions but, assessing the amount of volume that should be removed is a challenge since physical exam findings are not accurate. Ambulatory pulmonary artery (PA) pressure measurement is a promising intervention in HF that potentially could be used as well in CKD population, predicting volume status changes and allowing a promptly intervention. We presented two cases of patient with CKD, HF and cardioMEMS

Rapid 5 Lb Weight Gain Is Not Associated With Readmission In Patients With Heart Failure, Jill Howie-Esquivel, Kathleen Dracup, Mary A. Whooley, Charles Mcculloch, Chengshi Jin, Debra K. Moser, Robyn A. Clark, Michele M. Pelter, Martha J. Biddle, Linda G. Park

Nursing Faculty Publications

Aims Heart failure (HF) patients are taught to identify a rapid 5 lb body‐weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients.

Methods and results This was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries > 50% over 24 months (N = …

Hemodynamic, Therapeutic, And Clinical Outcomes Of Ambulatory Pressure-Guided Heart Failure Management, Jacob Abraham, Lian Wang, Rebecca Lewis, Katherine Callis, Joshua Remick, Kateri J. Spinelli

The VAD Journal

Background: Heart failure (HF) management guided by CardioMEMS™ pulmonary artery pressure (PAP) monitoring reduces PAP and HF hospitalizations. The objective of this project was to characterize the relationship between medication adjustments, PAP change, and outcomes for all patients at an advanced HF center.

Methods: We retrospectively analyzed medication changes and hospitalizations for 32 consecutive patients implanted with the CardioMEMS™ sensor at a single HF center and related these outcomes to PAP data from the Merlin.net (Abbott) database. Absolute change in PAP from baseline was estimated using area under the curve normalized to days monitored.

Results: Patients had an average change …

Restoration Of Left Ventricular Function Following Lvad Implantation – Remission Or Recovery? A Case Series., Shiksha Joshi, Mariah Barlow, Maya Guglin

The VAD Journal

Background

A wide range of left ventricular (LV) recovery rates on left ventricular assist device (LVAD) support have been reported. In this case series, we summarize our experience with LVAD explantation for presumed LV recovery.

Case series

Out of 240 patients who received an LVAD implant in our program since its inception, we explanted/inactivated the pump for presumed LV recovery in only three patients. All three of these patients had relapse of cardiomyopathy within 6 months of explantation.

Conclusion

Our experience does not support the existence of LV recovery following LVAD implantation as a common phenomenon. Improvement in LV function …

Trajectory Of Thirst Intensity And Distress From Admission To 4-Week Follow Up At Home In Patients With Heart Failure, Nana Waldréus, Misook L. Chung, Martje H. L. Van Der Wal, Tiny Jaarsma

Nursing Faculty Publications

Background: Patients with heart failure (HF) can suffer from increased thirst intensity and distress. Trajectories of thirst intensity and distress from hospital to home are unclear. The aim of this study was to describe thirst intensity and distress trajectories in patients from the time of hospital admission to 4 weeks after discharge, and describe trajectories of thirst intensity and distress by patients’ characteristics (gender, age, body mass index [BMI], plasma urea, anxiety, and depression).

Patients and methods: In this observational study, data were collected from patients with HF (n=30) at hospital admission, discharge, and at 2 and 4 weeks after …

Myocyte [Na+]I Dysregulation In Heart Failure And Diabetic Cardiomyopathy, Sanda Despa

Pharmacology and Nutritional Sciences Faculty Publications

By controlling the function of various sarcolemmal and mitochondrial ion transporters, intracellular Na⁺ concentration ([Na⁺]_i) regulates Ca²⁺ cycling, electrical activity, the matching of energy supply and demand, and oxidative stress in cardiac myocytes. Thus, maintenance of myocyte Na⁺ homeostasis is vital for preserving the electrical and contractile activity of the heart. [Na⁺]_i is set by the balance between the passive Na⁺ entry through numerous pathways and the pumping of Na⁺ out of the cell by the Na⁺/K⁺-ATPase. This equilibrium is perturbed in heart failure, …

What Did We Learn About Vads In 2017?, Maya Guglin

The VAD Journal

No abstract provided.

Cardiac-Specific Inactivation Of Lpp3 In Mice Leads To Myocardial Dysfunction And Heart Failure, Mini Chandra, Diana Escalante-Alcalde, Shenuarin Bhuiyan, Anthony Wayne Orr, Christopher Kevil, Andrew J. Morris, Hyung Nam, Paari Dominic, Kevin J. Mccarthy, Sumitra Miriyala, Manikandan Panchatcharam

Internal Medicine Faculty Publications

Lipid Phosphate phosphatase 3 (LPP3), encoded by the Plpp3 gene, is an enzyme that dephosphorylates the bioactive lipid mediator lysophosphatidic acid (LPA). To study the role of LPP3 in the myocardium, we generated a cardiac specific Plpp3 deficient mouse strain. Although these mice were viable at birth in contrast to global Plpp3 knockout mice, they showed increased mortality ~ 8 months. LPP3 deficient mice had enlarged hearts with reduced left ventricular performance as seen by echocardiography. Cardiac specific Plpp3 deficient mice had longer ventricular effective refractory periods compared to their Plpp3 littermates. We observed that lack of Lpp3 enhanced cardiomyocyte …

Lisinopril Or Coreg Cr In Reducing Cardiotoxicity In Women With Breast Cancer Receiving Trastuzumab: A Rationale And Design Of A Randomized Clinical Trial, Maya Guglin, Pamela Munster, Angelina Fink, Jeffrey Krischer

Internal Medicine Faculty Publications

Background—Trastuzumab (TZB) is an established therapy for HER2 positive breast cancer. The use of TZB is commonly associated with cardiotoxicity manifesting as asymptomatic decrease in left ventricular ejection fraction (LVEF) or overt heart failure. Several studies demonstrated favorable effects of angiotensin converting enzyme (ACE) inhibitors and beta blockers (BB) in the prevention of chemotherapy-induced cardiotoxicity. We hypothesize that patients, randomized to receive an ACE inhibitor or a beta-blocker during trastuzumab therapy for breast cancer, will maintain a higher LVEF than patients randomized to placebo.

Methods and Results—We designed a prospective, multicenter, randomized, phase II placebo-controlled clinical trial to …

Paranormal Activity: Para-Esophageal/Gastric Hemorrhage In A Patient With A Heartmate Ii Lvad, Anna Stone, Ashwin Ravichandran

The VAD Journal

In this report we present an unusual case of non-traumatic, spontaneous para-esophageal/para-gastric hemorrhage requiring multiple units of red blood cells in a female patient with a continuous flow left ventricular assist device. She presented with dysphagia and atypical chest pain 18 months post implantation, on the recommended anticoagulation regimen for HeartMate II support of ASA 81mg and international normalized ratio goal (INR) of 2-3 and was successfully managed with conservation support, volume resuscitation and multiple transfusions. Non-traumatic causes of acute bleeding, including acquired platelet dysfunction are considered.

Fatal Flaw - Driveline Fracture As A Rare But Serious Complication Of Mechanical Circulatory Support With Left Ventricular Assist Devices, Yuri Boyechko, Thomas Tribble, Maya Guglin

The VAD Journal

Background: Patients with advanced heart failure have seen decreased mortality and improved quality of life due to mechanical circulatory support with left ventricular assist devices (LVAD). Regardless of such outcomes, many complications still exist and remain a significant cause of morbidity and mortality. Our purpose is to study the prevalence, clinical course, and outcomes specifically of patients with LVAD driveline (DL) fractures.

Methods: This single-center, retrospective review included all patients at our institution who had continuous flow LVADs and experienced DL fracture/injury from January 2012 - December 2015.

Results: Thirteen of 110 LVAD patients (11.8%) had DL fractures (Table 1). …

Venoarterial Extracorporeal Membrane Oxygenation For Cardiogenic Shock: A Retrospective Analysis Based On The Etiology Of Shock, Andrew Burchett, Thomas Tribble, Richard Charnigo, Susan Smyth, Maya Guglin

The VAD Journal

Abstract:

Background: We performed a retrospective analysis to evaluate the efficacy of VA-ECMO support in cardiogenic shock based on various etiologies.

Methods: We retrospectively analyzed 99 patients supported with VA-ECMO from January 1, 2012 to January 1, 2015. Outcomes included survival to discontinuation of VA-ECMO support and survival to hospital discharge. The etiologies of cardiogenic shock included cardiac arrest (CPR), acute myocardial infarction (AMI), decompensated congestive heart failure (CHF), pulmonary embolism (PE), right ventricular failure (RVF) not secondary to an acute pulmonary embolism, and post-cardiotomy syndrome (PCS). The PCS group was used as a reference group; odds ratios were estimated …

Common Clinical Dilemmas In Left Ventricular Assist Device Therapy: A Glimpse Into Current Trends, Ahmet Kilic, Michael S. Kiernan, Meredith A. Brisco-Bacik, Sangjin Lee, Behzad Soleimani, Aditya Bansal, Igor Gosev, Peter Eckman, Brian Lima, Brian Bethea, Chetan B. Patel, Jason N. Katz, Jonathan D. Rich, Susan M. Joseph

The VAD Journal

Background

Left ventricular assist device (LVAD) therapy has been thrust into the forefront of surgical treatment for advanced heart failure (HF). Despite advancements in survival and quality of life with these devices, the multi-disciplinary care for these patients remains far from standardized across institutions.

Methods

A survey of current practices in LVAD was carried out at the St. Jude Medical User’s meeting representing a variety of caregivers including cardiac surgeons, HF cardiologists, non-HF cardiologists, advanced practice providers and ventricular assist device coordinators, with representation from several continents. Utilizing an audience response system, eleven questions were asked related to the demographics …

What Did We Learn About Vads In 2016?, Maya Guglin

The VAD Journal

No abstract provided.

Evaluation Of Depression Screening Implementation In The Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation, Jennifer Sustek

DNP Projects

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: …

Evaluation Of Oral Nutritional Supplement Use In Elderly Patients Admitted With Heart Failure, Geri L. Sipe

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effects of enhanced ordering privileges among registered dieticians (RD) on oral nutritional supplement (ONS) ordering frequency and prevalence of oral nutritional supplement use among elderly patients admitted with heart failure (HF).

METHODS: This study was a single facility, retrospective pre-post implementation evaluation of the impact of expanded ONS ordering privileges among elderly patients (age ≥ 65 years old) hospitalized with heart failure at Frankfort Regional Medical Center (FRMC). The sample consisted of 105 patients for the pre-evaluation period and 259 for the post-evaluation period.

RESULTS: There were …

Tolerability Of Intermittent Hemodialysis In A Cohort Of Patients With Left Ventricular Assist Device, Christopher Areephanthu, Amr Elhusseini, Bennet George, Jessica Mcabee, B. Peter Sawaya

The VAD Journal

Background: The use of left ventricular assist device (LVAD) has emerged as a popular treatment for patients with advanced heart failure. It is not uncommon for these patients to suffer from renal failure requiring renal replacement therapy. The purpose of this study is to assess hemodynamic parameters and ability to complete the prescribed hemodialysis session in a series of patients who underwent numerous dialysis treatments.

Methods: Nine patients with Heart Mate II LVAD received 170 intermittent inpatient hemodialysis treatments between January 1, 2010 and December 31, 2012. Assessment included vital signs, ultrafiltrate removed, hemodialysis duration, symptoms, early terminations (ET), and …

The Short-Term And Long-Term Effects Of Biofeedback-Assisted Relaxation Therapy In Patients With Heart Failure: A Randomized Control Study, Tsuey-Yuan Huang, Debra K. Moser, Shiow-Li Hwang

Nursing Faculty Publications

Background: Relaxation techniques can reduce sympathetic nervous system activation and stress, potentially improving heart failure patients’ physical and psychological outcomes.

Purpose: To examine the effects of biofeedback-assisted relaxation (BFAR) therapy in patients with heart failure.

Methods: A prospective randomized control study was conducted. Participants in the treatment group received BFAR therapy, while participants in the control group received standard of care. Short-term outcomes were physical symptoms and psychosocial variables measured at baseline and 3 months; long-term outcomes were cardiac events and mortality assessed at 12 months.

Results: Fifty-two heart failure patients participated in the study: 23 (mean age 60.0 ± …

Adverse Events In Continuous-Flow Lvad Recipients: Gastrointestinal Bleeding Is Still Notable?, Marija Petrovic, Sriram Nathan, Rajko Radovancevic, Indranee Rajapreyar, Kevin J. Dasher, Mehmet H. Akay, Bindu Akkanti, Pranav Loyalka, Biswajit Kar, Igor D. Gregoric

The VAD Journal

Background: The etiology and risk factors associated with gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVADs) are currently unknown. Therefore, we sought to assess the risk factors for GIB in these patients.

Design and Methods: This was a retrospective, non-randomized, non-controlled study at a single center. Between 2012 and 2014, 65 men and 6 women (mean age = 55 ± 12 years) underwent CF-LVAD implantation at our institution. Overall, 23.9% of patients (17/71) had at least one GIB episode. Endoscopy confirmed GIB in 13/17. Arteriovenous malformation was the major GIB source in 8/13 (61%). …

Cardiomems™ In Lvad Patients: A Case Series, Maya Guglin, Bennet George, Sarah Branam, Amanda Hart

The VAD Journal

Patients with a left ventricular assist device (LVAD) commonly encounter issues with volume status post-implant. Volume overload can result from incomplete compensation of left ventricular failure or from right ventricular failure. The CardioMEMS™ intracardiac hemodynamic monitoring device is an area of growing interest regarding the management of chronic congestive heart failure, however, its utility has not been serially investigated in patients with an LVAD. We present a case series of patients with ventricular assist devices care for at our institution in which the CardioMEMS™ device aided in the management of volume status and pump performance.

Ligation Of The Outflow Graft Of The Left Ventricular Assist Device For Management Of Hemolysis Due To Pump Thrombosis, Jean Touchan, Alexis Shafii, Maya Guglin

The VAD Journal

Pump thrombosis is a serious complication of continuous-flow left ventricular assist devices (LVAD). Treatment options include medical thrombolysis, surgical pump exchange or urgent heart transplantation. We are reporting a case of pump thrombosis with active hemolysis and acute renal failure managed surgically by isolating the LVAD while awaiting renal recovery and donor heart availability.

Normal Lactate Dehydrogenase Does Not Exclude Pump Thrombosis In Left Ventricular Assist Devices, Julie Shelton Do, Bennet George Md, Amanda Hart Bsn, Rn, Maya Guglin Md

The VAD Journal

Left ventricular assist device (LVAD) pump thrombosis is a well-known complication of LVAD placement. Elevated lactate dehydrogenase (LDH) has classically been the first objective marker of pump thrombosis. In this case, we present a patient found to have normal serum LDH values but was ultimately found to have significant pump thrombosis.

Exploring Body Mass Index Changes In Left Ventricular Assist Device Patients, Raquel E. Thomas, Corrine Hanson, Glenda Woscyna, Brian D. Lowes

The VAD Journal

Background: Current treatment options for end-stage heart failure, such as transplantation, can be limited by obesity guidelines. Mechanical devices such as Left Ventricular Assistive Devices (LVAD) can bridge heart failure patients to transplantation, however, after implantation; some patients may experience weight gain that precludes them from transplantation. Therefore, the objective of this study was to evaluate weight changes after the implantation of an LVAD.

Methods: A retrospective review of 130 patients receiving an LVAD were divided into two groups based on BMI at the time of implantation: obese (>30 kg/m²) and non-obese (/m²). Patients were …

A Protocol For Collecting Human Cardiac Tissue For Research, Cheavar A. Blair, Premi Haynes, Stuart G. Campbell, Charles Chung, Mihail I. Mitov, Donna Dennis, Mark R. Bonnell, Charles W. Hoopes, Maya Guglin, Kenneth S. Campbell

The VAD Journal

This manuscript describes a protocol at the University of Kentucky that allows a translational research team to collect human myocardium that can be used for biological research. We have gained a great deal of practical experience since we started this protocol in 2008, and we hope that other groups might be able to learn from our endeavors. To date, we have procured ~4000 samples from ~230 patients. The tissue that we collect comes from organ donors and from patients who are receiving a heart transplant or a ventricular assist device because they have heart failure. We begin our manuscript by …