Cardiovascular Diseases Commons^™

Modified Pull-Through Technique For Cardiac Resynchronization Therapy Upgrades In Patients With Occluded Access Veins, Guram Imnadze, Khaled Awad, Wolfgang Kranig, Irakli Giorgberidze

The Texas Heart Institute Journal

The number of procedures for upgrading implantable devices for cardiac resynchronization therapy has increased considerably during the last decade. A major challenge that operators face in these circumstances is occlusion of the access vein. We have modified a pull-through method to overcome this obstacle. Six consecutive patients with occluded access veins and well-developed collateral networks underwent a procedure in which the occluded vein was recanalized by snaring the existing atrial lead via transfemoral access. Upgrading the device was successful in all patients; none had intraprocedural complications. Our experience shows that our modified pull-through technique may be a feasible alternative for …

Obstruction Of 2 Coronary Arteries From Different Causes Immediately After Transapical Transcatheter Aortic Valve Replacement, Umihiko Kaneko, Ryuji Koshima, Hirosato Doi, Tsutomu Fujita

The Texas Heart Institute Journal

Coronary obstruction, a rare complication of transcatheter aortic valve replacement, can be fatal. Few data exist on this phenomenon, and, to date, authors have reported only single coronary lesions. We present a case in which 2 coronary arteries obstructed immediately after transapical transcatheter aortic valve replacement. The patient was an 81-year-old woman with symptomatic severe aortic stenosis who underwent transapical transcatheter aortic valve replacement. Immediately after an Edwards Sapien XT valve was deployed, she experienced sudden cardiogenic shock resulting from obstruction of the left main coronary artery ostium and the distal left anterior descending coronary artery. The left main obstruction …

Outcomes Following Percutaneous Coronary Intervention In Patients With Cancer, Raymundo A Quintana, Dominique J Monlezun, Giovanni Davogustto, Humberto R Saenz, Francisco Lozano-Ruiz, Daisuke Sueta, Kenichi Tsujita, Uri Landes, Ali E Denktas, Mahboob Alam, David Paniagua, Daniel Addison, Hani Jneid

Faculty, Staff and Students Publications

BACKGROUND: Randomized clinical trials demonstrated the benefits of percutaneous coronary interventions (PCI) in diverse clinical settings. Patients with cancer were not routinely included in these studies.

METHODS/RESULTS: Literature search of PubMed, Cochrane, Medline, SCOPUS, EMBASE, and ClinicalTrials was conducted to identify studies that assessed one-year all-cause, cardiovascular and non-cardiovascular mortality in patients with historical or active cancer. Using the random effects model, we computed risk ratios (RRs) and standardized mean differences and their 95% confidence intervals for the dichotomous and continuous measures and outcomes, respectively. Of 171 articles evaluated in total, 5 eligible studies were included in this meta-analysis. In …

Rationale And Design Of The Steroids To Reduce Systemic Inflammation After Infant Heart Surgery (Stress) Trial, Kevin D Hill, H Scott Baldwin, David P Bichel, Ryan J Butts, Reid C Chamberlain, Alicia M Ellis, Eric M Graham, Jesse Hickerson, Christoph P Hornik, Jeffrey P Jacobs, Marshall L Jacobs, Robert Db Jaquiss, Prince J Kannankeril, Sean M O'Brien, Rachel Torok, Joseph W Turek, Jennifer S Li, Stress Network Investigators

Faculty, Staff and Students Publications

For decades, physicians have administered corticosteroids in the perioperative period to infants undergoing heart surgery with cardiopulmonary bypass (CPB) to reduce the postoperative systemic inflammatory response to CPB. Some question this practice because steroid efficacy has not been conclusively demonstrated and because some studies indicate that steroids could have harmful effects. STRESS is a randomized, placebo-controlled, double-blind, multicenter trial designed to evaluate safety and efficacy of perioperative steroids in infants (age < 1 year) undergoing heart surgery with CPB. Participants (planned enrollment = 1,200) are randomized 1:1 to methylprednisolone (30 mg/kg) administered into the CPB pump prime versus placebo. The trial is nested within the existing infrastructure of the Society of Thoracic Surgeons Congenital Heart Surgery Database. The primary outcome is a global rank score of mortality, major morbidities, and hospital length of stay with components ranked commensurate with their clinical severity. Secondary outcomes include several measures of major postoperative morbidity, postoperative hospital length of stay, and steroid-related safety outcomes including prevalence of hyperglycemia and postoperative infectious complications. STRESS will be one of the largest trials ever conducted in children with heart disease and will answer a decades-old question related to safety and efficacy of perioperative steroids in infants undergoing heart surgery with CPB. The pragmatic "trial within a registry" design may provide a mechanism for conducting low-cost, high-efficiency trials in a heretofore-understudied patient population.

Catch 22 : To Anticoagulate Or Not To Anticoagulate, Muhammad Madkour, Patrick Hu

Internal Medicine

No abstract provided.

An Atypical Presentation Of Ivc Thrombosis, Samantha Gelman Md, Gregory Shimizu Md, Rajesh Gulati Md

Internal Medicine

No abstract provided.

Assessment Of Guideline Recommended Anti-Coagulation Rates For Atrial Fibrillation In An Outpatient Resident Clinic, Kanav Gupta Md, Emily Langnas Do, Zahra Khaled, Travis Tagami Do, Alexandra Halalau Md

Internal Medicine

No abstract provided.

Giant 75mm Intracranial Aneurysm Masquerading As Primary Malignancy, Andrew W. Hwang, Satvir Dhillon Md, Remus Popa

Internal Medicine

No abstract provided.

Is The Thomas Ring An Effective Approach To Prevent Recurrence Of Persistent Atrial Fibrillation With Advanced Atrial Fibrosis?, Ruifang Yang Md, Jose Luis Henao Md, David Goldgrab Do, Sokol Kalaveshi Md, Stephen Mester Md, Christian Perzanowski Md

Cardiology

Introduction | Objectives: Pulmonary vein isolation (PVI) with the Thomas ring (TR, single ring posterior wall isolation) has been shown to reduce recurrence of primarily paroxysmal atrial fibrillation (AF). Atrial fibrosis, as an important pathophysiological contributor, is directly linked to AF recurrence and resistance to therapy. The effect of TR ablation on outcomes of persistent AF (peAF) with advanced atrial fibrosis has not been adequately studied.

Methods: Observational series of three peAF patients (Tab.) who underwent TR. The degree of atrial fibrosis was determined by electroanatomic bipolar voltage mapping (CARTO, Diamond Bar, CA, USA). The reduced voltage areas (Fig.) reflected …

Ablation Of Persistent Atrial Fibrillation Substrate In Sinus Rhythm Does Not Lead To An Underestimation Of Fibrotic Atrial Myopathy: A Pilot Study, David Goldgrab Do, Sokol Kalaveshi Md, Jose Luis Henao Md, Ruifang Yang Md, Jearim Craig, Stephen Mester Md, Christian Perzanowski Md

Cardiology

Introduction | Objectives: Ablation of persistent atrial fibrillation (peAF) is associated with a worse outcome. Fibrotic atrial myopathy (FAM) is thought to play a role in the progression of AF. Estimation of left atrial voltage can vary significantly based on whether mapping is performed in fibrillatory conduction or sinus rhythm (SR). Selection of a voltage scale (VS) may lead to an over/under estimation of FAM. We determined the prevalence of advanced atrial myopathy (FAM > = 2) in SR compared to historical cohort ablated in peAF.

Methods: A homogenous group of peAF patients who underwent ablation in SR following cardioversion were …

Cardioversion Of Persistent Atrial Fibrillation Before High Energy Ablation Does Not Improve Outcomes In Short Term Follow Up: Preliminary Analysis, Ruifang Yang Md, Sokol Kalaveshi Md, David Goldgrab Do, Jose Luis Henao Md, Stephen Mester Md, Christian Perzanowski Md

Cardiology

Introduction | Objectives: The optimal approach of ablating persistent Atrial Fibrillation (peAF) has yet to be defined. By convention, mapping/ablation of peAF is most often performed in AF. The success of ablation hinges on catheter contact and achieving lesion transmurality. We theorized that ablation efficacy would improve during sinus rhythm (SR) given stability and predictability of catheter contact.

Methods: Non‐randomized comparison of peAF patients who underwent ablation in SR under a new practice protocol versus a cohort of peAF ablated in AF. The lesion set was the same for both groups, WACA ± BOX. Study group was treated with higher …

Retrospective Study Of Fmol Health System Utilization Using Geospatial Information, Deekshith Mandala

LSU Master's Theses

Medicaid Expansion and closing of Emergency Departments (ED) like Earl K. Long, Baton Rouge General Mid-City ED, and Champion Medical Center changed the health care landscape in East Baton Rouge Parish (EBRP). In this research study, a Geographical Information System (GIS) is used to analyze the impact of the expansion of Medicaid and the inauguration of Our Lady of the Lake North Baton Rouge ED (OLOL NBR ED) over the utilization of Franciscan Missionaries of our Lady Health System (FMOLHS) for both emergency and non-emergency health care services. This study is performed across the 58 neighborhoods of EBRP. Overutilization of …

Evidence For The Misfolding Of The A1 Domain Within Multimeric Von Willebrand Factor In Type 2 Von Willebrand Disease, Alexander Tischer, Maria A Brehm, Venkata R Machha, Laurie Moon-Tasson, Linda M Benson, Katelynn J Nelton, Rachel R Leger, Tobias Obser, Marina Martinez-Vargas, Steven T Whitten, Dong Chen, Rajiv K Pruthi, H Robert Bergen, Miguel A Cruz, Reinhard Schneppenheim, Matthew Auton

Faculty, Staff and Students Publications

Von Willebrand factor (VWF), an exceptionally large multimeric plasma glycoprotein, functions to initiate coagulation by agglutinating platelets in the blood stream to sites of vascular injury. This primary hemostatic function is perturbed in type 2 dysfunctional subtypes of von Willebrand disease (VWD) by mutations that alter the structure and function of the platelet GPIbα adhesive VWF A1 domains. The resulting amino acid substitutions cause local disorder and misfold the native structure of the isolated platelet GPIbα-adhesive A1 domain of VWF in both gain-of-function (type 2B) and loss-of-function (type 2M) phenotypes. These structural effects have not been explicitly observed in A1 …

Spotlight On Icosapent Ethyl For Cardiovascular Risk Reduction: Evidence To Date, Xiaoming Jia, Stephanie Koh, Mahmoud Al Rifai, Roger S. Blumenthal, Salim S. Virani

Office of the Provost

Icosapent ethyl is a highly purified formulation of eicosapentaenoic acid, a type of omega-3 fatty acid contained in fish oil. While omega-3 fatty acids have long been thought to have cardioprotective benefits, the Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT) has helped to establish icosapent ethyl as an evidence-based therapy for risk reduction of atherosclerotic cardiovascular disease (ASCVD). REDUCE-IT, however, was by no means an overnight success story. Close examination of the evidence shows that the trial was a culmination of many lessons learned from previous studies. The purpose of this manuscript is to review contemporary evidence of icosapent …

The Observational Investigation Of Vitamin D And The Effect On Hypertension (Oiveh) Study, Warren Burke

DNP Research Projects

Background

It is uncertain if vitamin D supplementation improves cardiovascular health, more specifically, the systolic and diastolic blood pressures, and the data from previous trials investigating supplementation and the effects on the blood pressure are limited.

Methods

The following scholarly project was a retrospective observational study, examining randomly selected participants with chronic kidney disease and hypertension from a local nephrology practice. The Student’s t-test, Pearson’s r correlation, and ANOVA statistical tests were utilized to determine if vitamin D supplementation improved the systolic and diastolic blood pressures.

Results

A total of 260 participants were examined. The mean systolic blood pressure …

Reducing Hypertension Through Faith Community Nursing, Michelle White

DNP Research Projects

Hypertension affects approximately 31.1% of adults (1.39 million) worldwide. It continues to be a significant risk factor for cardiovascular disease and strokes, the leading causes of death in the United States (Mills, Stefanescu, & He, 2020). Hypertension is expected to increase due to the aging population and unhealthy lifestyle choices of the American people (American Heart Association [AHA], 2018a). Therefore, effective strategies are required to manage hypertension in order to decrease stroke and cardiovascular events that can save the lives of many Americans. National programs such as Healthy People 2020 are working to achieve blood pressure control within the United …

Age And Functional Outcomes Post-Neurologic Insult In Patients Attending Inpatient Rehabilitation, Jonathan Bowman Spt, Elena Crooks Pt, Dpt, Phd, Doug Weeks Phd, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Neurologic insults such as strokes and traumatic brain injuries (TBI) affect over 1 million Americans every year. The lack of current knowledge informing accurate prognoses causes victims and their loved ones distress, and is a focus of much research. The purpose of this study was to determine whether patient age at time of insult could predict change in functional outcomes during inpatient rehabilitation.

Methods

Subjects were patients of an inpatient rehabilitation facility (IRF) post-stroke or TBI. The Functional Independence Measure (FIM) assessed functional independence and cognitive status at admission and discharge from the IRF. The Montebello Rehabilitation Factor Score …

A Systemic Review And Meta-Analysis On The Antihypertensive Effect Of Aromatherapy Essential Oils, Mikyoung Lee, Ji-Ah Song, Mina Ahn, Ahra Jo, Jeongah Park, Wonjong Kim, Claudia M. Davis, Yeon Sook Kim, Myun-Haeng Hur

Nursing Faculty Publications

Purpose: This study is a systemic review of experimental results on the effects of aromatherapy on blood pressure.

Materials and Methods: Journal articles published to December, 2017, were retrieved from twelve databases. Randomized controlled trials in which were evaluated for changes in blood pressure following aromatherapy were selected. Risks of bias were assessed using the risk-of-bias (ROB) tool of the Cochrane Collaboration. Meta-analysis were dine using RevMan.

Results: Of the 2545 articles retrieved from the electronic databases, 580 duplicate articles and 1891 articles that were unrelated to the PICO (patient/problem, intervention, comparison, outcome) elements or did not satisfy the inclusion …

Parental Nutrition Health Literacy, Sheila F. Towson

Regis University Student Publications (comprehensive collection)

Executive Summary

Parental Nutrition Health Literacy and Children’s Health

Problem: The problem identified in the following study is that overweight and obesity is associated with comorbidities that contribute to chronic diseases such as depression, decreased academic performance, type 2 diabetes, cardiac disease and others (Allesio, 2018; Barlow & Expert Committee, 2007). Demographics reveal obesity prevalence among children and adolescents to be 18.9% in the lowest income group, 19.9% in the middle-income group, and 10.9% in the highest income group (CDC, 2018). School and home environments are especially influential in affecting school-age children’s health behaviors (Luesse, Paul, Koch, Contendo, & Marsick, …

Exposure To Household Secondhand Smoke Among Adolescents In Kuwait: Results From Two School-Based Cross-Sectional Studies, Ali H. Ziyab, Mohammad Almari, Abdullah Al-Taiar

Community & Environmental Health Faculty Publications

INTRODUCTION: Detrimental effects of secondhand smoke (SHS) exposure are well established; however, data on SHS exposure among adolescents in Kuwait are lacking. Hence, this study sought to estimate the prevalence of household SHS exposure among two samples of adolescents in Kuwait and assess its variation by socioeconomic status and parental education level.

METHODS: Data from two large school-based cross-sectional studies were analyzed. Adolescents attending public middle (n=3864; aged 11-14 years) and high (n=1959; aged 14-19 years) schools throughout Kuwait were enrolled in 2016-2017, and parental self-reported household SHS exposure was ascertained. Associations were assessed using Poisson regression with robust variance …

Implementation Of A Dose Response To Wood Smoke Pm: A Potential Method To Further Explain Cvd In Wildland Firefighters., Dylan Richmond, John Quindry, Christopher T. Migliaccio, Brent Ruby

Graduate Student Theses, Dissertations, & Professional Papers

The presentation of cardiovascular disease (CVD) and comorbidities in aging and retired wildland firefighters (WLFF) continues to be one of the top health priorities to address by The United States Forest Service. In the past 20 years, experts at multiple meetings and conferences have confronted this growing concern as a formal call to action to investigation the individual components related to working in the wildland fire setting. The inhalation of wood smoke particulate matter (PM) shows evidence of altering homeostasis in WLLF’s in the areas of oxidative stress, inflammation, and arterial stiffness, all of which contribute to the development of …

The Effects Of An Inflammasome Inhibitor Olt1177 On The Development Of Ischemic Heart Failure, Joseph S. Aliaga

Theses and Dissertations

Thesis Abstract

THE EFFECTS OF AN INFLAMMASOME INHIBITOR OLT1177 ON THE DEVELOPMENT OF ISCHEMIC HEART FAILURE

By Joseph S. Aliaga, BS

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University.

Virginia Commonwealth University, 2020

Background: Evidence suggests that prolonged and enhanced pro-inflammatory signaling, modulated by the NLRP3 inflammasome, plays a crucial role in the pathophysiology of several different types of cardiovascular diseases such as acute myocardial infarction (AMI), adverse ventricular remodeling, and heart failure (HF). Consequently, we hypothesize that attenuating the enhanced inflammatory response using a pharmacological NLRP3 …

The Role Of Interleukin-18 In Myocardial Ischemia/Reperfusion, Yogesh Dhakal

Theses and Dissertations

Acute Myocardial Infarction (AMI) is one of the leading causes of morbidity for cardiovascular diseases (CVDs) in the western world. While mortality rates for AMI has reduced in the last 20 years due to advancements in clinical interventions, patients who have an AMI are significantly more likely to develop heart failure (HF) in the following years. Reperfusion of the ischemic tissue is a necessary procedure to restore blood delivery to cardiomyocytes, minimize myocardial dysfunction, and reduce infarct size. Still, the step of reperfusion itself induces myocardial damage in a phenomenon known as reperfusion injury. Considering that the degree of myocardial …

Age, Gender, And Racial Differences Between Acute Myocardial Infarction, Type 2 Diabetes, And Their Comortality, Steven Borchers

Scholarship in Medicine - All Papers

Acute myocardial infarction and type two diabetes are within the top seven causes of death in the United States and their impact on society is costly. Although there are many studies conducted about these diseases, some of the research is aged and requires more recent datasets. The objective of this research is to revel trends in these diseases, as well as in their comorbidity, relating to age, gender, and race. To conduct this research, data has been collected from the CDC Wonder dataset using their comorbidity database. This comorbidity data uses USA death certificates from 1999-2017 to retrieve the medical …

Associations Between Psychosocial Stressors, Genes, And Cardiovascular Disease In At-Risk Adults, Kaitlin Voigts Key

Theses and Dissertations--Nursing

Psychosocial stressors have a significant adverse impact on cardiovascular health. While better medical treatments and increased emphasis on healthy lifestyle have improved cardiovascular health for many in the United States over the past 50 years, there are persistent inequities in cardiovascular disease (CVD) rates, with the highest rates among populations burdened by chronic exposure to psychosocial stressors such as discrimination and anxiety, among others. Genetic factors may interact with these stressors further influencing the rates of CVD in these populations. The purpose of this dissertation is to examine associations among psychosocial stressors and other CVD risk factors, and the influence …

Responses To Symptoms Among Patients With Heart Failure, Chin-Yen Lin

Theses and Dissertations--Nursing

Patients with heart failure (HF) suffer from chronic and progressive symptoms. Failure to respond appropriately to escalating symptoms of HF causes a delay in seeking care, which results in worse symptom status, frequent rehospitalizations, and contributes to higher mortality. In order to enhance HF self-care, promote timely care-seeking, and improve outcomes, identification of factors that affect patients’ responses to symptoms and their decisions to seek care is essential. Thus, the purposes of this dissertation were to (1) identify factors associated with patients’ responses to worsening HF symptoms, and (2) determine the impact of responses to symptoms on outcomes in patients …

Involvement Of The Renin Angiotensin System In Marfan Syndrome Associated Thoracic Aortic Aneurysms, Jeff Zheying Chen

Theses and Dissertations--Physiology

Thoracic aortic aneurysms (TAAs) are clinically-silent dilations of the aorta which greatly increase the risk of aortic rupture, a condition with 50-90% mortality. Marfan syndrome (MFS) is caused by mutations in fibrillin-1 (FBN1) and is associated with TAAs. Due to an absence of validated and effective pharmacologic therapies to prevent or reverse TAA, most MFS patients require surgical aortic repair. Understanding MFS associated TAA pathogenesis would direct development of new pharmacologic therapies. Previous research has implicated the renin angiotensin system in TAA. In both males and females, angiotensinogen (AGT) is cleaved serially to generate the main effector peptide angiotensin II …

Cardiac Effects Of Obesity During Pregnancy In C57bl/6j Mice, Kayla Lynn Dudick

Theses and Dissertations--Nutrition and Food Systems

Objective: Pregnancy requires profound cardiac and metabolic adaptation. Left ventricular (LV) mass is increased in response to pregnancy, but is not associated with cardiac damage. In contrast, obesity-mediated cardiac hypertrophy is pathological. Data from animal studies indicate dietary fatty acid composition may have a protective effect during states of extreme cardiac physiological adaptation. In contrast, aberrant cardiac metabolism is a hallmark of disease. Over a third of reproductive-age women in the United States are obese, but there is a paucity of data describing the effect of obesity on maternal cardiac adaptation to pregnancy. The objective of this study was to …

Cardiometabolical Risk Factors Associated With Renal Function In Apparently Healthy Young Students: A Cross-Sectional Study, Lucia M. Perez-Navarro, Rafael Valdez-Ortiz, Araceli Alegria-Diaz, Miguel Murgia-Romero, Rafael Jimenez-Flores, Rafael Villalobos-Molina, Srinivas Mummidi, Ravindranath Duggirala, Juan C. Lopez-Alvarenga

School of Medicine Publications

Background: Cardiometabolic risk factors (CMRFs) appear decades before developing chronic kidney disease (CKD) in adulthood.

Objective: The objective of the study was to identify the prevalence and association between CMRFs and kidney function in apparently healthy young adults (18-25 years old).

Methods: We included 5531 freshman year students. Data collected on CMRFs included central obesity, high body mass index (hBMI >25), blood pressure, glycemia, lipids, uric acid (UA >6.8 mg/dL), and insulin. Glomerular filtration rate (GFR) was estimated by CKD-Epidemiology Collaboration formula. We used logistic regression and a log linear for odds ratio (OR) (95% confidence level) and probabilities.

Results: …

The Efficacy Of Adding Eicosapentaenoic Acid To Statin Monotherapy In The Prevention Of Acute Coronary Syndrome In Patients With Coronary Artery Disease, Carlo Escudero

Capstone Showcase

Introduction: Coronary artery disease (CAD) is a chronic medical condition caused by the buildup of plaque within the coronary artery endothelium. If left untreated it can progress to an acute coronary syndrome (ACS) which can lead to myocardial ischemia and death. Statins are lipid lowering agents used in clinical practice for the medical management of CAD. However, incidence of major adverse cardiovascular (CV) events still occurs despite optimal statin therapy. Currently eicosapentaenoic acid (EPA) has been promoted to be effective when added to statin therapy in lowering the incidence of CV events in patients with hypercholesterolemia. This paper will address …