Cardiovascular Diseases Commons^™

29th Annual Scientific Congress Of Hong Kong College Of Cardiology Proceedings

Journal of the Hong Kong College of Cardiology

No abstract provided.

24th Asc Of Icsm Proceedings

Journal of the Hong Kong College of Cardiology

No abstract provided.

29th Annual Scientific Congress Of Hong Kong College Of Cardiology Abstracts

Journal of the Hong Kong College of Cardiology

No abstract provided.

24th Asc Of Icsm Abstracts

Journal of the Hong Kong College of Cardiology

No abstract provided.

The Role Of Telehealth In Reducing Hospital Readmissions For Heart Failure Patients, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Heart failure affects over six million people annually, and is expected to increase to over eight million by 2030. Over 60 million people live in the rural United States. Telehealth is a tool to improve access to care, provide early intervention, and follow up with patients within 48 hours of a hospital discharge. Utilizing Telehealth to conduct a medication reconciliation within 48 hours of discharge to address any medication errors or admission, and reinforce adherence is a way to improve access to care to those living in rural areas.

The Enigma Of Primary Hypertension In Childhood, Bonita Falkner

Department of Medicine Faculty Papers

Beginning in the 1970s, hypertension in children and adolescents has been defined as systolic and/or diastolic blood pressure (BP) that is equal to or greater than the 95th percentile of the normal BP distribution in healthy children. The definition of hypertension in adults is based on longitudinal data that links a BP level with an increased risk for subsequent adverse outcomes related to hypertension including heart failure, kidney failure, stroke, or death. The statistical definition of hypertension continues to be used in childhood because there have been no data that link a BP level in childhood with a heightened risk …

Relationship Between Preprocedural Lipid Levels And Periprocedural Myocardial Injury In Patients Undergoing Elective Percutaneous Coronary Intervention, Mohsen Maadani, Nima Sari Sarraf, Sanam Alilou, Kamran Aeinfar, Parham Sadeghipour, Ali Zahedmehr, Mahmood Sheikh Fathollahi, Seyyed Isa Hashemi Ghadi, Abbas Zavarehee, Maryam Zolfaghari, Reza Zolfaghari

The Texas Heart Institute Journal

BACKGROUND: Periprocedural myocardial injury is a predictor of cardiovascular morbidity and mortality after percutaneous coronary intervention.

METHODS: The authors examined the effects of preprocedural lipid levels (low-density lipoprotein, high-density lipoprotein, and triglycerides) in 977 patients with coronary artery disease who underwent elective percutaneous coronary intervention.

RESULTS: Elevated cardiac troponin I level (≥5× the upper limit of normal) was used to indicate periprocedural myocardial injury. Serum lipid samples were collected 12 hours preprocedurally. Cardiac troponin I was collected 1, 6, and 12 hours postprocedurally. Correlations between preprocedural lipid levels and postprocedural cardiac troponin I were studied. Low-density lipoprotein levels were less …

Dilated Cardiomyopathy With Multiple Left Ventricular Thrombi And Embolic Stroke After Mild Covid-19, Radhapriya Yalamanchi, Madhan Kumar Murugan, Krishnaswamy Chandrasekharan, Refai Showkathali

The Texas Heart Institute Journal

COVID-19 is a novel disease with multisystem involvement, but most patients have pulmonary and cardiovascular involvement in the acute stages. The cardiovascular impact of acute COVID-19 is well recognized and ranges from myocarditis, arrhythmias, and thrombotic occlusion of coronary arteries to spontaneous coronary artery dissection and microthrombi in small coronary vessels on autopsy. We report a case of a 37-year-old man who recovered from mild COVID-19 only to present a few weeks later with devastating cardiovascular involvement that included severe left ventricular impairment resulting from nonischemic cardiomyopathy, multiple left ventricular thrombi, and embolic stroke.

Usefulness Of A Perfusion Balloon For Intraprocedural Stent Thrombosis In A Patient With St-Segment Elevated Myocardial Infarction Complicated With Cardiogenic Shock, Taro Takeyama, Yukiko Mizutani, Tetsuya Ishikawa, Kota Yamada, Hidehiko Nakamura, Shiro Nakahara, Isao Taguchi

The Texas Heart Institute Journal

Intraprocedural stent thrombosis is a rare but serious complication of reperfusion therapy for acute coronary syndrome. There is currently no consensus on the intraprocedural management of intraprocedural stent thrombosis. It is difficult to attain thrombolysis in myocardial infarction flow grade 3, particularly in cases of cardiogenic shock. A 49-year-old man who presented with anterior ST-segment elevated acute myocardial infarction with cardiogenic shock underwent emergency percutaneous coronary intervention to diffuse proximal lesions in the left anterior descending artery under the support of intra-aortic balloon pumping. Intraprocedural stent thrombosis occurred following the postdilations with a 3.5- × 38-mm everolimus-eluting stent. Despite administration …

Myocarditis Mimicking Stress-Induced (Takotsubo) Cardiomyopathy, Arzu Canan, Ryan C Van Woerkom, Prabhakar Shantha Rajiah

The Texas Heart Institute Journal

No abstract provided.

Effects Of Escalating Temporary Mechanical Circulatory Support In Patients With Worsening Cardiogenic Shock, Iyad N Isseh, Sarah Gorgis, Carina Dagher, Shivani Sharma, Mir B Basir, Sachin Parikh

The Texas Heart Institute Journal

BACKGROUND: Cardiogenic shock-related mortality is substantial, and temporary mechanical circulatory support (MCS) devices are frequently used. The authors aimed to describe patient characteristics and outcomes in patients with worsening cardiogenic shock requiring escalation of temporary MCS devices.

METHODS: Worsening cardiogenic shock was defined as persistent hypotension, increasing doses of vasopressors/inotropes, worsening hypoperfusion, or worsening invasive hemo-dynamics. Escalation of temporary MCS devices was defined as adding or exchanging an existing MCS device. Variables were evaluated by logistic regression models and receiver operating characteristic curves.

RESULTS: From July 1, 2016, to July 1, 2018, a total of 81 consecutive patients experienced worsening …

Rad Regulation Of Cav12 Channels Controls Cardiac Fight-Or-Flight Response, Arianne Papa, Sergey I Zakharov, Alexander N Katchman, Jared S Kushner, Bi-Xing Chen, Lin Yang, Guoxia Liu, Alejandro Sanchez Jimenez, Robyn J Eisert, Gary A Bradshaw, Wen Dun, Shah R Ali, Aaron Rodriques, Karen Zhou, Veli Topkara, Mu Yang, John P Morrow, Emily J Tsai, Arthur Karlin, Elaine Wan, Marian Kalocsay, Geoffrey S Pitt, Henry M Colecraft, Manu Ben-Johny, Steven O Marx

Faculty, Staff and Student Publications

Fight-or-flight responses involve β-adrenergic-induced increases in heart rate and contractile force. In the present study, we uncover the primary mechanism underlying the heart's innate contractile reserve. We show that four protein kinase A (PKA)-phosphorylated residues in Rad, a calcium channel inhibitor, are crucial for controlling basal calcium current and essential for β-adrenergic augmentation of calcium influx in cardiomyocytes. Even with intact PKA signaling to other proteins modulating calcium handling, preventing adrenergic activation of calcium channels in Rad-phosphosite-mutant mice (4SA-Rad) has profound physiological effects: reduced heart rate with increased pauses, reduced basal contractility, near-complete attenuation of β-adrenergic contractile response and diminished …

Medication Complexity Among Older Adults With Hf: How Can We Assess Better?, Min Ji Kwak, Monica Cheng, Parag Goyal, Dae Hyun Kim, Scott L Hummel, Abhijeet Dhoble, Ashish Deshmukh, Rajender Aparasu, Holly M Holmes

Faculty, Staff and Student Publications

Medical management of heart failure (HF) has evolved and has achieved significant survival benefits, resulting in highly complex medication regimens. Complex medication regimens create challenges for older adults, including nonadherence and increased adverse drug events, especially associated with cognitive impairment, physical limitations, or lack of social support. However, the association between medication complexity and patients' health outcomes among older adults with HF is unclear. The purpose of this review is to address how the complexity of HF medications has been assessed in the literature and what clinical outcomes are associated with medication regimen complexity in HF. Further, we aimed to …

The Impact Of Covid-19 On Patients With Ibd In A Prospective European Cohort Study, Rana O Afifi

Faculty, Staff and Student Publications

No abstract provided.

The Impact Of Vitamin A Deficiency On Tuberculosis Progression, Antonio F Corno, Jorge D Salazar

Faculty, Staff and Student Publications

No abstract provided.

A Case Of Isolated Cardiac Burkitt Lymphoma Causing Right-Sided Heart Failure, Graham Rector, Stephanie J Koh, Rashed Tabbaa

The Texas Heart Institute Journal

Primary cardiac tumors are rare, as the most common cause of cardiac masses is from metastatic disease. In this article, a unique case of isolated cardiac Burkitt lymphoma causing right-sided heart failure in a 70-year-old man who presented to the emergency department with abdominal distension and lower-extremity swelling is described. The right ventricular mass was initially identified via computed tomographic scans of the abdomen and pelvis. Further workup included transthoracic echocardiogram and cardiac magnetic resonance imaging that showed extension of the mass into the right atrium and pericardium. Staging imaging and bone marrow biopsy revealed no evidence of metastatic disease. …

Objective Evaluation Of Clock Face Suture Using The Objective Structured Assessment Of Technical Skill Checklist, Lucille Treil, Nicole Neumann, Nicolas Chanes, Anne Lejay, Tristan Bourcier, Jean Bismuth, Jason T. Lee, Malachi Sheahan, Anne Florence Rouby, Nabil Chakfé, John Eidt, Yannick Georg, Erica Leith Mitchell, David Rigberg, Murray Shames, Fabien Thaveau, Claudie Sheahan

School of Medicine Faculty Publications

Objective: Assessment of the quality of the final product (QFP) is critical in simulation training, such as the clock face suture (CFS) exercise that is used to assess trainees’ needle handling and suturing accuracy. Objective Structured Assessment of Technical Skill (OSATS) scores are the gold standard for the evaluation of trainees. The aim was to investigate variability in the use of OSATS checklists and to evaluate a semi-automatic method of suture analysis vs. OSATS scores. Methods: Details of 287 CFSs performed by trainees during Fundamentals in Vascular Surgery examinations were collected. All were rated according to a seven item OSATS …

Factors Influencing The Use Of Postoperative Bilevel Positive Airway Pressure (Bipap) In Patients Undergoing Adult Cardiac Surgery: A Retrospective Cohort Study, Syed Shabbir Ahmed, Muhammad Saad Yousuf, Khalid Samad, Hameed Ullah, Khalid Maudood Siddiqui

Department of Anaesthesia

Background and aims: Respiratory complications are one of the biggest challenges following cardiac surgery, which can lead to hypoxia and acute respiratory failure (ARF). The aim of this study to identify the factors led to BiPAP application for postoperative respiratory complications and its effectiveness as the main outcome measures after cardiac surgery.
Methods: It was a retrospective cohort study with consecutive sampling technique. A total of 335 postcardiac surgery patients medical record was reviewed who were underwent for surgery from November 1, 2018 to November 30, 2019. 265 patients were finalized for the recruitment, five patients were excluded before the …

Trends, Predictors, And Outcomes Of Transcatheter Aortic Valve Implantation In Patients With Bicuspid Aortic Valve Related Disease: Insights From The Nationwide Inpatient Sample And Nationwide Readmission Database, Waqas Ullah, Salman Zahid, Hamza Muhammadzai, Fouad Khalil, Arnav Kumar, Abdul Mannan Khan Minhas, Muhammad Zia Khan, Salim S. Virani, David L. Fischman, Pinak Shah

Office of the Provost

Background: Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with bicuspid aortic valve (BAV) related aortic stenosis (AS) with insufficient large-scale data on its safety.
Methods: The Nationwide Inpatient Sample and Nationwide Readmission Database (2011-2018) were queried to identify patients undergoing TAVI for BAV versus trileaflet aortic valve (TAV) associated AS. The in-hospital, 30- and 180-day odds of outcomes were assessed using a propensity-matched analysis (PSM) to calculate adjusted odds ratios (aOR) with its 95% confidence interval (CI).
Results: A total of 216,723 TAVI (TAV: 214,050 and BAV: 2,673) crude and 5,347 matched population (TAV: 2,674 and …

Association Of Cerebrovascular Stability Index And Head Circumference Between Infants With And Without Congenital Heart Disease, Nhu N Tran, Michelle Tran, Ashok Panigrahy, Ken M Brady, Jodie K Votava-Smith

Faculty, Staff and Student Publications

Congenital heart disease (CHD) is a common birth defect in the United States. CHD infants are more likely to have smaller head circumference and neurodevelopmental delays; however, the cause is unknown. Altered cerebrovascular hemodynamics may contribute to neurologic abnormalities, such as smaller head circumference, thus we created a novel Cerebrovascular Stability Index (CSI), as a surrogate for cerebral autoregulation. We hypothesized that CHD infants would have an association between CSI and head circumference. We performed a prospective, longitudinal study in CHD infants and healthy controls. We measured CSI and head circumference at 4 time points (newborn, 3, 6, 9 months). …

Self-Expanding Transcatheter Vs Surgical Aortic Valve Replacement In Intermediate-Risk Patients: 5-Year Outcomes Of The Surtavi Randomized Clinical Trial, Nicolas M Van Mieghem, G Michael Deeb, Lars Søndergaard, Eberhard Grube, Stephan Windecker, Hemal Gada, Mubashir Mumtaz, Peter S Olsen, John C Heiser, William Merhi, Neal S Kleiman, Stanley J Chetcuti, Thomas G Gleason, Joon Sup Lee, Wen Cheng, Raj R Makkar, Juan Crestanello, Barry George, Isaac George, Susheel Kodali, Steven J Yakubov, Patrick W Serruys, Rüdiger Lange, Nicolo Piazza, Mathew R Williams, Jae K Oh, David H Adams, Shuzhen Li, Michael J Reardon

Faculty, Staff and Student Publications

IMPORTANCE: In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.

OBJECTIVE: To report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.

DESIGN, SETTING, AND PARTICIPANTS: SURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. …

In Vivo Evaluation Of A New Hybrid Graft Using Retrograde Visceral Perfusion For Thoracoabdominal Aortic Repair In An Animal Model, Sabine Wipper, Harleen K Sandhu, Tilo Kölbel, Anthony L Estrera, Constantin Trepte, Christoph Behem, Charles C Miller, E Sebastian Debus

Faculty, Staff and Student Publications

OBJECTIVES: The SPIDER technique for hybrid thoracoabdominal aortic aneurysm repair can avoid thoracotomy and extracorporeal circulation. To improve technical feasibility and safety, the new Thoracoflo graft, consisting of a proximal stent graft connected to a 7-branched abdominal prosthesis, was evaluated in a pig model for technical feasibility testing, before implantation in humans.

METHODS: Retroperitoneal exposure of the infradiaphragmatic aorta, including visceral and renal arteries, was performed in 7 pigs (75-85 kg). One iliac branch was temporarily attached to the distal aorta to maintain retrograde visceral and antegrade iliac perfusion after deployment of the thoracic stent graft segment (SPIDER technique). The …

Cardio-Onco-Metabolism – Metabolic Vulnerabilities In Cancer And The Heart, Anja Karlstaedt, Heinrich Taegtmeyer

Faculty, Staff and Student Publications

Cancer and cardiovascular diseases (CVDs) are the leading cause of death worldwide. Metabolic remodeling is a hallmark of both cancer and the failing heart. Tumors reprogram metabolism to optimize nutrient utilization and meet increased demands for energy provision, biosynthetic pathways, and proliferation. Shared risk factors for cancer and CVDs suggest intersecting mechanisms for disease pathogenesis and progression. In this review, we aim to highlight the role of metabolic remodeling in cancer and its potential to impair cardiac function. Understanding these mechanisms will help us develop biomarkers, better therapies, and identify patients at risk of developing heart disease after surviving cancer.

The Development And Initial Validation Of The Promis®+Hf-27 And Promis+Hf-10 Profiles, Faraz S Ahmad, Kathryn L Jackson, Susan E Yount, Nan E Rothrock, Michael A Kallen, Leilani Lacson, Karl Y Bilimoria, Abel N Kho, Raja Kannan Mutharasan, Peter A Mccullough, Jeffrey Bruckel, Savitri Fedson, Stephen E Kimmel, David T Eton, Kathleen L Grady, Clyde W Yancy, David Cella

Center for Medical Ethics and Health Policy Staff Publications

Aims: Heart failure (HF) is a common and morbid condition impacting multiple health domains. We previously reported the development of the PROMIS®-Plus-HF (PROMIS+HF) profile measure, including universal and HF-specific items. To facilitate use, we developed shorter, PROMIS+HF profiles intended for research and clinical use.

Methods and results: Candidate items were selected based on psychometric properties and symptom range coverage. HF clinicians (n = 43) rated item importance and clinical actionability. Based on these results, we developed the PROMIS+HF-27 and PROMIS+HF-10 profiles with summary scores (0-100) for overall, physical, mental, and social health. In a cross-sectional sample (n = 600), we …

The Development And Growth Of Cardio-Oncology Or Onco-Cardiology, Bernard Man Yung Cheung, Chu Pak Lau

Journal of the Hong Kong College of Cardiology

No abstract provided.

The Value Of 3d Vena Contracta Area In A Patient With Degenerative Mitral Regurgitation And Multiple Jets, Shing Ching, Chiu Sun Yue

Journal of the Hong Kong College of Cardiology

Quantification of degenerative mitral regurgitation with multiple jets in atrial fibrillation is challenging with two dimensional techniques and may underestimate the severity. We report the feasibility and advantages of vena contracta area in three dimensional transesophageal echocardiography in evaluation of such a patient.

From Bad To Worse: The Clinical Spectrum Of Immune Checkpoint Inhibitor Myocarditis And Associated 3m Syndrome With Concomitant Myositis And Myasthenia, Tsun-Ho Lam, Jeffrey Sum-Lung Wong, Chun-Ka Wong, Gerry Gin Wai Kwok, Miaochang Zhou, Benjamin Yu-Fai So, Ian Yu-Hin Leung, Hung-Fat Tse

Journal of the Hong Kong College of Cardiology

Immune checkpoint inhibitors (ICIs), though revolutionizing cancer care, are well known to cause a diverse array of autoimmune side effects termed immune-related adverse events (IRAEs). ICI Myocarditis is a rare manifestation of IRAE associated with high mortality. We report two cases of fulminant ICI myocarditis refractory to potent immunosuppressants. Our first patient received pembrolizumab for lymphoma, small cell lung cancer and renal cell carcinoma. After 13 doses of ICIs, he developed fulminant myocarditis with concomitant lower-motor neuron type facial nerve palsy. Despite receiving triple immunosuppressive therapies with pulse steroid, mycophenolate mofetil and basiliximab, his cardiac condition progressively worsened and eventually …

Epidemiology And Characteristics Of Surgical Intervention For Infective Endocarditis: A Population-Based Study In The Past Two Decades (2000 – 2019) In Hong Kong, Hang-Long Li, Yi-Kei Tse, Cong Chen, Si-Dong Cai, Meng-Qi Su, Mei-Zhen Wu, Qing-Wen Ren, Jia-Yi Huang, Si-Yeung Yu, Yap-Hang Chan, Hung-Fat Tse, Kai-Hang Yiu

Journal of the Hong Kong College of Cardiology

Background

The ‘inflamm-ageing’ phenomenon may worsen the prognosis of heart diseases including infective endocarditis (IE), while surgery may reduce inflammatory burden by direct removal of bacterial vegetation. This study aims to characterize the epidemiological and clinical features of surgical intervention for IE in Hong Kong in the past two decades.

Methods

All patients with incident IE from 2000-2019 in a territory-wide database were identified. We studied the trends in age-specific incidence of IE and identified the most significant contributors to 1-year all-cause death using the population attributable fraction (PAF). A propensity score approach was used to evaluate the benefits of …

Indicators Of Cardiac Autonomic Dysfunction Associated With Chronic Hyperglycemia: Implications On Vascular Surrogates And Heart Failure, Yap-Hang Chan, Bernard Man-Yung Cheung, Hung-Fat Tse

Journal of the Hong Kong College of Cardiology

Background: Limited data exist on the role of chronic hyperglycemia-related cardiac autonomic dysfunction in incident heart failure (HF). We investigated the relations of resting heart rate (HR) and PR interval with chronic hyperglycemia, and effects on new-onset HF.

Methods: We prospectively studied 550 patients with prior coronary disease, ischemic stroke and/ or type 2 diabetes. Incident HF was ascertained. Heart rate-PR interval dissociation was defined as counter-physiological co-occurrence of increased PR interval (>mean; 173.3ms) and increased resting HR (>mean; 64.4 beats/min).

Results: Over 63 ±11 months, 6.7% patients developed new-onset HF. Resting HR³75bpm was independently predictive of new-onset …

Clinical Features And Prognosis Of Chinese Childhood Pulmonary Arterial Hypertension-Related Gene Mutation Carriers, Zhuoyuan Xu, Hongsheng Zhang, Chen Zhang, Qiangqiang Li, Hong Gu

Journal of the Hong Kong College of Cardiology

Background: The impact of PAH-related gene mutations on the clinical phenotype are not yet fully understood, especially in childhood.

Methods: Retrospective study of 114 pediatric Chinese Han population whose onset of PAH was between 3 months and 18 years of age with IPAH were performed. Whole exome sequencing results, clinical characteristics, treatments and outcomes were recorded in all patients.

Results: Thirty-one BMPR2, nine ACVRL1 and 33 other PAH-related gene mutation carriers were detected in this cohort. The median age at diagnosis of PAH was 5.9 (3.4,10.3) years. 54 (47.4%) patients were female. 80 patients including 59 mutation carriers underwent right …