Medicine and Health Sciences Commons^™

Physical Exertion As A Risk Factor For Ventricular Arrhythmia: A Prospective Cohort Study, Harpreet S. Chahal

Electronic Thesis and Dissertation Repository

Episodes of physical exertion are associated with an immediately higher risk of cardiovascular events while physical activity over the long-term is cardioprotective. To assess the transient and long-term risk of ventricular arrhythmia (VA), we conducted a nested case-crossover study within a prospective cohort of 97 patients with implantable cardioverter-defibrillators (ICD). Within an hour of episodes of exertion, the risk of VA was 5.3 (95% CI 2.7 – 10.6) times greater compared to periods of rest. The association was higher among patients with aerobic fitness below the median (RR[relative risk]=17.5, 95% 5.2 – 58.5) than for patients with aerobic fitness above …

Isosorbide Mononitrate In Heart Failure With Preserved Ejection Fraction., Margaret M. Redfield, Kevin J. Anstrom, James A. Levine, Gabe A. Koepp, Barry A. Borlaug, Horng H. Chen, Martin M. Lewinter, Susan M. Joseph, Sanjiv J. Shah, Marc J. Semigran, G. Michael Felker, Robert T. Cole, Gordon R. Reeves, Ryan J. Tedford, W.H. Wilson Tang, Steven E. Mcnulty, Eric J. Velazquez, Monica R Shah, Eugene Braunwald

Division of Cardiology Faculty Papers

BACKGROUND: Nitrates are commonly prescribed to enhance activity tolerance in patients with heart failure and a preserved ejection fraction. We compared the effect of isosorbide mononitrate or placebo on daily activity in such patients.

METHODS: In this multicenter, double-blind, crossover study, 110 patients with heart failure and a preserved ejection fraction were randomly assigned to a 6-week dose-escalation regimen of isosorbide mononitrate (from 30 mg to 60 mg to 120 mg once daily) or placebo, with subsequent crossover to the other group for 6 weeks. The primary end point was the daily activity level, quantified as the average daily accelerometer …

Efficacy And Safety Of Vorapaxar In Non-St-Segment Elevation Acute Coronary Syndrome Patients Undergoing Noncardiac Surgery, Sean Van Diepen, Pierluigi Tricoci, Mohua Podder, Cynthia M. Westerhout, Philip E. Aylward, Claes Held, Frans Van De Werf, John Strony, Lars Wallentin, David J. Moliterno, Harvey D. White, Kenneth W. Mahaffey, Robert A. Harrington, Paul W. Armstrong

Gill Heart & Vascular Institute Faculty Publications

Background—Perioperative antiplatelet agents potentially increase bleeding after non–ST‐segment elevation (NSTE) acute coronary syndromes (ACS). The protease‐activated receptor 1 antagonist vorapaxar reduced cardiovascular events and was associated with increased bleeding versus placebo in NSTE ACS, but its efficacy and safety in noncardiac surgery (NCS) remain unknown. We aimed to evaluate ischemic, bleeding, and long‐term outcomes of vorapaxar in NCS after NSTE ACS.

Methods and Results—In the TRACER trial, 2202 (17.0%) patients underwent major or minor NCS after NSTE ACS over 1.5 years (median); continuing study treatment perioperatively was recommended. The primary ischemic end point for this analysis was cardiovascular …

Overweight Predicts Poorer Exercise Capacity In Congenital Heart Disease Patients, Karen Kuehl, Alicia Tucker, Munziba Khan, Paula Goldberg, E. Anne Greene, Megan Smith

Pediatrics Faculty Publications

Background

Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults.

Methods

Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85–95 or > 95 percentile respectively for age and gender …

Background Differences In Baseline And Stimulated Mmp Levels Influence Abdominal Aortic Aneurysm Susceptibility, Matthew A. Dale, Melissa K. Suh, Shijia Zhao, Trevor Meisinger, Linxia Gu, Vicki J. Swier, Devendra K. Agrawal, Timothy Greiner, Jeffrey S. Carson, B. Timothy Baxter, Wanfen Xiong

Department of Mechanical and Materials Engineering: Faculty Publications

Objective: Evidence has demonstrated profound influence of genetic background on cardiovascular phenotypes. Murine models in Marfan syndrome (MFS) have shown that genetic background-related variations affect thoracic aortic aneurysm formation, rupture, and lifespan of mice. MFS mice with C57Bl/6 genetic background are less susceptible to aneurysm formation compared to the 129/SvEv genetic background. In this study, we hypothesize that susceptibility to abdominal aortic aneurysm (AAA) will be increased in 129/SvEv mice versus C57Bl/6 mice. We tested this hypothesis by assessing differences in aneurysm size, tissue properties, immune response, and MMP expression.

Methods: Mice of C57Bl/6 or 129/SvEv background underwent AAA induction …

Interaction Of Alu Polymorphisms And Novel Measures Of Discrimination In Association With Blood Pressure In African Americans Living In Tallahassee, Alexis C. Boulter, Jackyn Quinlan, Aida T. Miró-Herrans, Laurel N. Pearson, Nubiana L. Todd, Clarence C. Gravlee, Connie J. Mulligan

Human Biology Open Access Pre-Prints

African Americans are 40% more likely to be afflicted with hypertension in comparison to non-Hispanic, white Americans, resulting in a 30% higher instance of mortality due to cardiovascular disease. There is debate about the relative contributions of genetic and sociocultural risk factors to the racial disparity in hypertension.

We assayed three Alu insertion polymorphisms located in the angiotensin-1-converting enzyme (ACE), tissue plasminogen activator (PLAT), and with no-lysine kinase 1 (WNK1) genes. We also estimated West African genetic ancestry and developed novel measures of perceived discrimination to create a biocultural model of blood pressure among …

Icloudecg: A Mobile Cardiac Telemedicine System, David S. Clifford

Masters Theses

With rising healthcare costs and a substantially growing number of patients 65 or over, the benefits of telemedicine and patient self-monitoring systems are becoming increasingly evident. Patients, physicians, hospitals, and even insurance providers benefit from vigilant, cost-effective patient monitoring systems. This thesis describes the development of a portable, smart-phone connected system for continuous cardiac monitoring. The system is capable of continuously monitoring the conditions of the heart, automated detection of cardiac arrhythmias, and real-time notifying patients and physicians of the detected abnormalities. The system consists of four main subsystems: 1) a Bluetooth capable chest-strap ECG, 2) an Android-enabled mobile device, …

Examining Older Adults' Perceptions Of Usability And Acceptability Of Remote Monitoring Systems To Manage Chronic Heart Failure, Lorraine S. Evangelista, Debra K. Moser, Jung-Ah Lee, Alison A. Moore, Hassan Ghasemzadeh, Majid Sarrafzadeh, Carol M. Mangione

Nursing Faculty Publications

Objective: This study was conducted to evaluate the feasibility, usability, and acceptability of using remote monitoring systems (RMS) in monitoring health status (e.g., vital signs, symptom distress) in older adults (≥ 55) with chronic heart failure (HF). Method: Twenty-one patients (52.4% women, mean age 73.1 ± 9.3) were trained to measure and transmit health data with an RMS. Data transmissions were tracked for 12 weeks. Results: All participants initiated use of RMS within 1 week; 71%, 14%, and 14% of patients transmitted daily health data 100%, ≥ 75%, and < 75% of the time, respectively, for 12 weeks. Overall usability and acceptability of the RMS were 4.08 ± 0.634 and 4.10 ± 0.563, respectively (when scored on a range of 1-5, where 1 = strongly disagree and 5 = strongly agree). Discussion: Findings show …

Score Big For Decreasing Mortality: Icd Risk Score Model, Linda Francaviglia, Rachel Petersen, Maria Stone, M. Eyman Mortada

Journal of Patient-Centered Research and Reviews

Background: Aurora Health Care, a system of 14 acute care hospitals in eastern Wisconsin, has been a long-time participant in the American College of Cardiology’s National Cardiovascular Data Registries, submitting data to its ICD Registry™ since 2005. Our system’s implantable cardioverter-defibrillator (ICD) procedure volume averages 930 cases annually. During 2012 we experienced an increase in in-hospital mortality/morbidity for ICD cases.

Purpose: A single-center study examining in-hospital mortality/morbidity post-ICD implant before and after changes in practice and patient selection.

Methods: ICD implants and generator changes discharged from January 1, 2009, to December 31, 2012, were included in developing a risk model …

A Meta-Analysis Of Incidence And Risk Factors Of Trastuzumab-Induced Cardiotoxicity In Breast Cancer, Zeeshan Ali Jawa, Ruth M. Perez, Lydia Garlie, Maharaj Singh, Rubina Qamar, Bijoy K. Khandheria, Arshad Jahangir, Yang Shi

Journal of Patient-Centered Research and Reviews

Background: A monoclonal antibody, trastuzumab targets the human epidermal growth factor receptor 2 (HER2) oncogene that is overexpressed in 25–30% of breast cancers. In combination with first-line therapy, trastuzumab resulted in significant improvement in survival outcomes for those with HER2-positive metastatic breast cancer. Due to its improvement in outcome and prolonged survival, trastuzumab has been established as standard of care in both adjuvant and metastatic settings. However, along with common adverse events, trastuzumab has been found to be associated with cardiotoxicity. An estimated 1–4% of patients treated with trastuzumab will develop heart failure and ~10% of patients will experience a …

Feasibility Of Atrial Delivery And Tracking Of Stem Cells In A Porcine Model, Nina Garlie, Timothy Hacker, Eric G. Schmuck, Jill Koch, Jayant Khitha, Amish Raval, Indrajit Choudhuri

Journal of Patient-Centered Research and Reviews

Background: Many patients undergoing open heart surgery have sinus node dysfunction and atrial fibrillation, leading to adverse outcomes. Mesenchymal stem cells (MSC) delivered at the time of surgery may have a reparative effect on atrial tissue, thereby improving sinus node function and reducing or preventing atrial fibrillation. Stem cell delivery to the atrium is entirely unstudied. This is a significant gap in medical research, as atrial disease contributes significantly to health care costs.

Purpose: The purpose of this pilot study is to establish a technique to deliver MSC to the atria through an open-chest model, to assess the safety of …

The Effect Of Percutaneous Closure Of Large Atrial Septal Defects On Right Ventricular Function In Adults, Armaan Shaikh, Alejandro Lopez-Mas, Suhail Allaqaband, Bijoy K. Khandheria, Abraham Getenet, Matt M. Umland, Maharaj Singh, Tanvir Bajwa

Journal of Patient-Centered Research and Reviews

Background: Percutaneous closure of atrial septal defects has been shown to be a safe alternative to surgery. Despite this, past studies have largely been focused on either small- to medium-sized atrial septal defects or percutaneous closure in children and young adults.

Purpose: Our study sought to examine if right ventricular function and size improved after percutaneous closure of large atrial septal defects in the adult population.

Methods: Over a 5-year span, 25 patients underwent percutaneous closure of a secundum atrial septal defect with an occluder device. A retrospective examination was conducted for each patient, including both echocardiography and chart review …

Contemporary Usage Of Intra-Arterial Catheter-Directed Thrombolytic (Cdt) Power Pulse Spray With Rheolytic Thrombectomy In Failed Cdt Alone For Acute Limb Ischemia, Hani Hashim, M. Fuad Jan, Maharaj Singh, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta

Journal of Patient-Centered Research and Reviews

Background: Acute lower limb ischemia (ALI) caused by arterial embolism, thrombosis of native vessels, and/or grafts is a serious condition associated with substantial morbidity and mortality. Peripheral arterial thrombolysis utilizing catheter-directed thrombolytic (CDT) has become established as a useful option in the management of ALI. However, use and outcome of adjunctive power pulse spray with rheolytic thrombectomy (PPSRT) following unsuccessful CDT is underreported in the literature.

Purpose: To evaluate outcome of contemporary use of intra-arterial CDT PPSRT as an adjunct to unsuccessful standard CDT for ALI.

Methods: We reviewed 78 consecutive patients (mean age 69 ± 14.2 years, 48.8% female) …

Real-World Relevance Of Manual Electrocardiography Qt Interval Measurement, Satish Velagapudi, Zahra Nur Khaled, Bilal Omery, Firas Zahwe, Michael Anigbogu, Sarah Zukkoor, Indrajit Choudhuri

Journal of Patient-Centered Research and Reviews

Background: Electrocardiography (ECG) QT interval (QTI) prolongation independently predicts sudden death. Hospitalized patients are commonly exposed to multiple QT-prolonging drugs, and manual measurement of ECG QTI based on identifying the intersection of isoelectricity with the tangent to the terminal phase T-wave slope (QTTTT) is advocated due to inaccuracies in automated detection algorithms that may imprecisely identify QT duration.

Purpose: We evaluated the performance of QTTTT compared to a standard automated (12SL, GE Healthcare) method (QT-12SL).

Methods: Consecutively obtained ECGs of 250 hospitalized patients were reviewed. The QTI in leads II, aVR, V5 and V6 determined by QT-12SL and QTTTT were …

Coronary Aorta Systolic And Diastolic Pressure Indices: Two Novel Indicators For Predicting Significant Coronary Stenosis –– A Validation Against Fractional Flow Reserve, Mirza Mujadil Ahmad, Khawaja Afzal Ammar, Mirza Nubair Ahmad, Arsalan Riaz, Fatima A. Husain, Syed Shahab Kazmi, Imran Husain, Anjan Gupta

Journal of Patient-Centered Research and Reviews

Background: Since most of the coronary flow occurs in diastole, either mean Pd/Pa or iFR has been used to measure the hemodynamic significance of a coronary stenosis. We have observed that a significant pressure gradient exists in coronary stenosis even in systole, which is contrary to general understanding but similar to ankle brachial index. Furthermore, prior studies have evaluated baseline Pd/Pa (mean coronary artery/mean aorta pressure) ratio as well as iFR (instantaneous wave-free ratio obtained during entire period of diastole) to predict fractional flow reserve (FFR) ≤ 0.80. We hypothesized a simple end-systolic and -diastolic pressure measurement in the coronary …

Cardiopulmonary Exercise Testing-Based Algorithm And Its Usefulness In Clinical Cardiology, Mirza Nubair Ahmad, Syed Hasan Yusuf, Rafath Ullah, Mary Ellis, Haroon Yousaf, Timothy E. Paterick, Khawaja Afzal Ammar

Journal of Patient-Centered Research and Reviews

Background: Only cardiopulmonary exercise (CPX) testing provides information on the ability of the cardiovascular system to meet the body’s metabolic demands in terms of oxygen consumption (VO₂) and carbon dioxide production (VCO₂). However, CPX testing is underutilized by cardiologists due to complex diagnostic algorithms involving up to 30 variables as well as lack of validation studies. In addition, CPX also provides oxygen (O₂) pulse as a continuous measure of stroke volume, which is its superiority to other stress modalities in which systolic function is measured at peak stress and rest. In the literature, it …

Echocardiographic Predictors Of Admission Among Patients With Heart Failure With Reduced Ejection Fraction, Chi C. Cho, Yang Shi, Robyn Shearer, Nasir Z. Sulemanjee, Dianne L. Zwicke, T. Edward Hastings, Omar M. Cheema, Vinay Thohan

Journal of Patient-Centered Research and Reviews

Background: Congestive heart failure afflicts 5.7 million people in the United States with annual incidence of 600,000 and mortality of 280,000. Heart failure accounts for greater than 1 million hospitalizations annually and the single largest inpatient Medicare expense. As the U.S. population ages and greater emphasis is placed on population health as a means to bend projected health care expenditures, large health care organizations will need to develop algorithms to identify patients at high risk with heart failure and possibly preempt hospitalizations. Doppler echocardiography is routinely performed in clinical assessment of severe heart failure.

Purpose: We sought to determine echocardiographic …

Stent Thrombosis: Regional Prevalence, Risk Factors, And Outcomes, Andrew M. Ayers, Chi C. Cho, Robyn Shearer, M. Fuad Jan, Anjan Gupta

Journal of Patient-Centered Research and Reviews

Background: Stent thrombosis is an infrequent but catastrophic complication of percutaneous coronary intervention (PCI). Many studies usually involve few stent thrombosis patients, generally less than 60, given its prevalence. While dual antiplatelet therapy has decreased stent thrombosis significantly in the general population, there are still patients who present with occurrence and recurrence of stent thrombosis.

Purpose: We sought to define the prevalence of site-specific stent thrombosis in a larger cohort of patients by specific coronary territories and determine if this had an effect on cardiovascular outcomes. In addition we sought to elucidate the role of previous coronary artery bypass grafting …

Low-Dose Vitamin K Can Improve Warfarin Control In Patients On Lvad Support, Daizo Tanaka, Venessa L. Kotch, Cheryl Abbas, Gordon Reeves, John Wc Entwistle Iii

The VAD Journal

Background

Anticoagulation with oral vitamin K antagonists (VKA) is very important in patients supported on a left ventricular assist device (LVAD) to prevent thromboembolic complications. Some patients tolerate VKAs poorly and have an unstable INR as a result. It is reported that low-dose vitamin K can improve INR control in patients with an unstable INR in other clinical settings. We evaluated its safety and effectiveness in patients on LVAD support.

Methods

The records of all patients supported on an implantable LVAD between January, 2013 and March, 2014 were reviewed retrospectively to identify those who had received low-dose vitamin K while …

Damaging Cardiac And Cancer Genetic Variants In The Lvad Population, Brian D. Lowes Md, Phd, Eric T. Rome, Kajari Dhar, Jeff Kittrell, James D. Eudy, John Y. Um, Alexandra Moulton, J. Zao, Ronald Redder, Michael J. Moulton, Daniel R. Anderson, Eugenia Raichlin

The VAD Journal

Background: Next generation sequencing technology, coupled with population genetic databases, have made broad genetic evaluation relatively inexpensive and widely available. Our objective was to assess the prevalence of potentially damaging cancer and cardiac gene variants in advanced non-ischemic cardiomyopathy patients.

Methods: Explanted human heart tissue procured at LVAD placement was obtained from the University of Nebraska Medical Center Heart Tissue Bank. Genomic DNA was isolated from tissues and amplified by PCR using targeted ampliseq primer pools from an inherited disease panel. Individual libraries were amplified by emulsion PCR on Ion Sphere particles and sequencing was performed on a …

Optical Imaging Of Finger For Blood Pressure Monitoring Of The Driver, Mohammad Motasim Bellah, Mohammad Raziul Hasan, Samir M. Iqbal

Electrical and Computer Engineering Faculty Publications and Presentations

Cardiovascular diseases (CVDs) are number one reason for human mortality around the world (Fig. 1) [1]. Pulse pressure (PP) and pulse rate (PR) are considered as the two most vital physiological markers for CVDs like myocardial infarction, cardiac arrhythmia, and heart failure. Currently, long-term PP and PR analysis is not possible due to the lack of systems that can frequently measure the data over a period of time. Motor vehicle drivers with known CVDs are at higher risk due to traffic air pollution.

This paper presents our work on an inexpensive and readily deployable approach that keeps track of PP …

Clinical Images - An Incidental Ekg, Ellen A. Thompson, Md, Mark A. Studeny, Md

Ellen A. Thompson

A routine employment stress test reveals Brugada syndrome, a rare abnormality.

Notching Early Repolarization Pattern In Inferior Leads Increases Risk Of Ventricular Tachyarrhythmias In Patients With Acute Myocardial Infarction: A Meta-Analysis., Zhiwei Zhang, Konstantinos P Letsas, Yajuan Yang, Panagiotis Korantzopoulos, Guangping Li, Gan-Xin Yan, Tong Liu

Department of Medicine Faculty Papers

The aim of this of this meta-analysis was to examine the potential association between certain early repolarization (ER) characteristics and ventricular tachyarrhythmias (VTAs) in patients with acute myocardial infarction (AMI). We searched PubMed, Embase and Web of Science databases for records published until December 2014. Of the 658 initially identified records, 7 studies with a total of 1,565 patients (299 with ER and 1,266 without ER) were finally analyzed. Overall, patients with ER displayed a higher risk of VTAs following AMI compared to patients without ER [odds ratio (OR): 3.75, 95% CI: 2.62-5.37, p < 0.00001]. Subgroup analyses showed that the diagnosis of ER prior to AMI onset is a better predictor of VTAs (OR: 5.70, p < 0.00001) compared to those diagnosed after AMI onset (OR: 2.60, p = 0.00001). Remarkably, a notching morphology was a significant predictor of VTAs compared to slurring morphology (OR: 3.85, p = 0.002). Finally, an inferior ER location (OR: 8.85, p < 0.00001) was significantly associated with increased risk of VTAs in AMI patients. In conclusion, our meta-analysis suggests that ER pattern is associated with greater risk of VTAs in patients with AMI. A notched ER pattern located in inferior leads confers the highest risk for VTAs in AMI.

Saving Life And Brain With Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Analysis Of In-Hospital Cardiac Arrests., Graham Peigh, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

OBJECTIVE: Despite advances in medical care, survival to discharge and full neurologic recovery after cardiac arrest remains less than 20% after cardiopulmonary resuscitation. An alternate approach to traditional cardiopulmonary resuscitation is extracorporeal cardiopulmonary resuscitation, which places patients on extracorporeal membrane oxygenation during cardiopulmonary resuscitation and provides immediate cardiopulmonary support when traditional resuscitation has been unsuccessful. We report the results from extracorporeal cardiopulmonary resuscitation at the Thomas Jefferson University.

METHODS: Between 2010 and June 2014, 107 adult extracorporeal membrane oxygenation procedures were performed at the Thomas Jefferson University. Patient demographics, survival to discharge, and neurologic recovery of patients who underwent extracorporeal …

Right Ventricular Dysfunction After Resuscitation Predicts Poor Outcomes In Cardiac Arrest Patients Independent Of Left Ventricular Function., Vimal Ramjee, Anne V. Grossestreuer, Yuan Yao, Sarah M. Perman, Marion Leary, James N. Kirkpatrick, Paul R. Forfia, Daniel M. Kolansky, Benjamin S. Abella, David F. Gaieski

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction.

METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012.

PATIENTS: 291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous …

Tools For Economic Analysis Of Patient Management Interventions In Heart Failure Cost-Effectiveness Model: A Web-Based Program Designed To Evaluate The Cost-Effectiveness Of Disease Management Programs In Heart Failure., Shelby D. Reed, Matthew P. Neilson, Matthew Gardner, Yanhong Li, Andrew H. Briggs, Daniel E E. Polsky, Felicia L. Graham, Margaret T. Bowers, Sara C. Paul, Bradi B. Granger, Kevin A. Schulman, David J. Whellan, Barbara Riegel, Wayne C. Levy

Department of Medicine Faculty Papers

BACKGROUND: Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable.

METHODS: We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying …

Gadolinium Free Cardiovascular Magnetic Resonance With 2-Point Cine Balanced Steady State Free Precession, Tori A. Stromp, Steve W. Leung, Kristin N Andres, Linyuan Jing, Brandon K. Fornwalt, Richard Charnigo, Vincent L. Sorrell, Moriel H. Vandsburger

Saha Cardiovascular Research Center Faculty Publications

BACKGROUND: Cardiovascular magnetic resonance (CMR) of ventricular structure and function is widely performed using cine balanced steady state free precession (bSSFP) MRI. The bSSFP signal of myocardium is weighted by magnetization transfer (MT) and T1/T2-relaxation times. In edematous and fibrotic tissues, increased T2 and reduced MT lead to increased signal intensity on images acquired with high excitation flip angles. We hypothesized that acquisition of two differentially MT-weighted bSSFP images (termed 2-point bSSFP) can identify tissue that would enhance with gadolinium similar to standard of care late gadolinium enhancement (LGE).

METHODS: Cine bSSFP images (flip angles of 5° and …

Clinical Images - An Incidental Ekg, Ellen A. Thompson, Md, Mark A. Studeny, Md

Marshall Journal of Medicine

A routine employment stress test reveals Brugada syndrome, a rare abnormality.

Racial Disparities In Intravenous Recombinant Tissue Plasminogen Activator Use Persist At Primary Stroke Centers., Hugo J. Aparicio, Brendan G. Carr, Scott E. Kasner, Michael J. Kallan, Karen C. Albright, Dawn O. Kleindorfer, Michael T. Mullen

Department of Emergency Medicine Faculty Papers

BACKGROUND: Primary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt-PA) than non-PSCs. The impact of PSCs on racial disparities in rt-PA use is unknown.

METHODS AND RESULTS: We used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt-PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were …

Early Manifestations Of Atrial Tamponade In A Patient Implanted With Syncardia Total Artificial Heart., Manoj Thangam, Bindu Akkanti, Sriram Nathan, Daniel Ocazionez-Trujillo, Indranee Rajapreyar, Manish K. Patel, Jayesh Patel, Pranav Loyolka, Biswajit Kar, Igor Gregoric

The VAD Journal

Implantation rates of the SynCardia Total Artificial Heart (TAH) system is growing owing to the increasing incidence of biventricular heart failure and the limited number of transplantable hearts. Among the complications associated with the device, atrial tamponade is an emergent condition that requires immediate attention. Atrial tamponade occurs when increasing pericardial hemorrhage leads to atrial compression that produces tamponade physiology and compromises cardiac output. Unfortunately to our knowledge, information concerning the early manifestations of tamponade in TAH patients is extremely scarce. Previous reports have focused on decreased cardiac output as an indicator of tamponade. However, other presentations including pulmonary decompensation …