Medical Specialties Commons^™

Sevoflurane Induces Cardioprotection Through Reactive Oxygen Species-Mediated Upregulation Of Autophagy In Isolated Guinea Pig Hearts., Mayumi Shiomi, Masami Miyamae, Genzou Takemura, Kazuhiro Kaneda, Yoshitaka Inamura, Anna Onishi, Shizuka Koshinuma, Yoshihiro Momota, Toshiaki Minami, Vincent M. Figueredo

Division of Cardiology Faculty Papers

PURPOSE: Sevoflurane increases reactive oxygen species (ROS), which mediate cardioprotection against myocardial ischemia-reperfusion injury. Emerging evidence suggests that autophagy is involved in cardioprotection. We examined whether reactive oxygen species mediate sevoflurane preconditioning through autophagy.

METHODS: Isolated guinea pigs hearts were subjected to 30 min ischemia followed by 120 min reperfusion (control). Anesthetic preconditioning was elicited with 2 % sevoflurane for 10 min before ischemia (SEVO). The ROS-scavenger, N-(2-mercaptopropionyl) glycine (MPG, 1 mmol/l), was administered starting 30 min before ischemia to sevoflurane-treated (SEVO + MPG) or non-sevoflurane-treated (MPG) hearts. Infarct size was determined by triphenyltetrazolium chloride stain. Tissue samples were obtained …

Combination Of Necroptosis And Apoptosis Inhibition Enhances Cardioprotection Against Myocardial Ischemia-Reperfusion Injury., Shizuka Koshinuma, Masami Miyamae, Kazuhiro Kaneda, Junichiro Kotani, Vincent M. Figueredo

Division of Cardiology Faculty Papers

PURPOSE: Necroptosis has been proposed as a mode of cell death that is a caspase-independent programmed necrosis. We investigated whether necroptosis is involved in myocardial ischemia-reperfusion injury in isolated guinea pig hearts and, if so, whether simultaneous inhibition of necroptosis and apoptosis confers enhanced cardioprotection.

METHODS: Isolated perfused guinea pig hearts were subjected to 30 min ischemia and 4 h reperfusion (control = CTL, n = 8). Necrostatin-1 (necroptosis inhibitor, 10 μM), Z-VAD (apoptosis inhibitor, 0.1 μM) and both inhibitors were administered starting 5 min before ischemia and during the initial 30 min of reperfusion (Nec, Z-VAD, Nec + Z-VAD; …

Meditation: Should A Cardiologist Care?, Stephen Olex, Andrew B. Newberg, Md, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Meditation refers to a family of practices that may share many similarities, but can have differences in underlying methods and goals. Religious and spiritual associations are common but are not requisite for meditation practice and it should be recognized that the basis of many if not all practices is the training of the brain and body, a process that appears to have profound effects on both structure and function. In recent decades there has been interest regarding the effects of these ancient practices on the cardiovascular system, as meditation has intuitive appeal for benefit in this area. Though there is …

Sevoflurane Confers Additive Cardioprotection To Ethanol Preconditioning Associated With Enhanced Phosphorylation Of Glycogen Synthase Kinase-3Β And Inhibition Of Mitochondrial Permeability Transition Pore Opening., Anna Onishi, Masami Miyamae, Hiroshi Inoue, Kazuhiro Kaneda, Chika Okusa, Yoshitaka Inamura, Mayumi Shiomi, Shizuka Koshinuma, Yoshihiro Momota, Vincent M. Figueredo

Division of Cardiology Faculty Papers

OBJECTIVE: The purposes of this study were to investigate whether sevoflurane (SEVO) enhances moderate-dose ethanol (EtOH) preconditioning and whether this additional cardioprotection is associated with glycogen synthase kinase-3β (GSK-3β), protein kinase B (Akt), mammalian target of rapamycin (mTOR), 70-kDa ribosomal s6 kinase-1 (p70s6K), and/or mitochondrial permeability transition pore (MPTP) opening.

DESIGN: In vitro study using an isolated heart Langendorff preparation.

SETTING: University research laboratory.

PARTICIPANTS: Male guinea pigs (n = 170).

INTERVENTIONS: Isolated perfused guinea pig hearts underwent 30-minute ischemia and 120-minute reperfusion (control). The EtOH group received 5% EtOH in the drinking water for 8 weeks. Anesthetic preconditioning was …

Hdl-C: Does It Matter? An Update On Novel Hdl-Directed Pharmaco-Therapeutic Strategies., Ramprasad Gadi, Aman Amanullah, Vincent M. Figueredo

Division of Cardiology Faculty Papers

It has long been recognized that elevated levels of low-density lipoprotein cholesterol (LDL-C) increase the risk of cardiovascular disease (CHD) and that pharmacologic therapy to decrease LDL-C significantly reduces cardiovascular events. Despite the effectiveness of statins for CHD risk reduction, even optimal LDL-lowering therapy alone fails to avert 60% to 70% of CHD cases. A low plasma concentration of high-density lipoprotein cholesterol (HDL-C) is also associated with increased risk of CHD. However, the convincing epidemiologic data linking HDL cholesterol (HDL-C) to CHD risk in an inverse correlation has not yet translated into clinical trial evidence supporting linearity between HDL-C increases …

Association Between Obesity And Infarct Size: Insight Into The Obesity Paradox., Beatriz Cepeda-Valery, Md, Leandro Slipczuk, Md, Vincent M. Figueredo, M.D., Gregg S. Pressman, D Lynn Morris, Md, Carl J Lavie, Md, Abel Romero-Corral, Md

Division of Cardiology Faculty Papers

Abstract:

Background: In patients with coronary heart disease, being overweight or obese is associated with better outcomes, a phenomenon known as the 'obesity paradox'. Despite the high prevalence of obesity in the United Sates, its effects on infarct size are largely unexplored.

Methods: Prospective cross-sectional study of 102 consecutive patients admitted with acute myocardial infarction (MI). Standardized forms were used to collect data on body mass index (BMI), waist circumference (WC), cardiovascular risk factors, and medications. Peak troponin I and creatinine phosphokinase (CPK) were used to estimate infarct size. Epicardial and pericardial fat were measured by echocardiography. We used univariate …

Alcohol And The Heart: To Abstain Or Not To Abstain?, Rajesh Movva, Md, Mrcp, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Alcohol has been consumed by most societies over the last 7000 years. Abraham Lincoln said "It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing." Light to moderate alcohol consumption reduces the incidence of coronary heart disease (CHD), ischemic stroke, peripheral arterial disease, CHD mortality, and all-cause mortality, especially in the western populations. However, heavy alcohol consumption is detrimental causing cardiomyopathy, cardiac arrhythmias, hepatic cirrhosis, pancreatitis, and hemorrhagic stroke. In this article, we review the effects of alcohol on CHD, individual cardiovascular risk …

A Review Of Nutritional Factors In Hypertension Management., Ha Nguyen, Olaide A Odelola, Janani Rangaswami, Aman Amanullah

Department of Medicine Faculty Papers

Hypertension is a major health problem worldwide. Its attendant morbidity and mortality complications have a great impact on patient's quality of life and survival. Optimizing blood pressure control has been shown to improve overall health outcomes. In addition to pharmacological therapies, nonpharmacological approach such as dietary modification plays an important role in controlling blood pressure. Many dietary components such as sodium, potassium, calcium, and magnesium have been studied substantially in the past decades. While some of these nutrients have clear evidence for their recommendation, some remain controversial and are still of ongoing study. Dietary modification is often discussed with patients …

Cardio-Oncology For The 21st Century: Introduction., Marc L Schwartz, Md

Division of Cardiology Faculty Papers

Based on the latest statistics the prognosis for patients with malignancy has dramatically improved. The overall 5 year survival rate for those who were diagnosed with a cancer between 2002 and 2008 was approximately 65%¹, and as of 2008, 12 million Americans were cancer survivors.² However, this extended longevity now exposes these patients to the risk of other health issues related to their primary cancer or to the treatment that ensured their survival. Specifically, patients who have not succumbed prematurely to their oncologic disease may develop cardiovascular disease that is either a result of the long-term effects …

Distribution Of Dyssynchrony In Subjects With No Known Cardiac Disease And Comparison Of Velocity Vector Imaging To Color-Coded Tissue Doppler Imaging., Anoop C Parameswaran, Bhaskar Purushottam, Aman Amanullah, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Data on the distribution of dyssynchrony in subjects with normal ejection fraction (EF) and normal QRS are scarce. We studied 100 subjects with no known cardiac disease (52% male, mean age 60 ± 17 years) using velocity vector imaging (VVI). Seventeen percent had septal to lateral (S-L) wall longitudinal delay >75 msec, 63% of subjects had S-L wall radial delay >75 msec, and 25% had a circumferential opposing wall delay >100 msec. Those with circumferential opposing wall delay of >100 msec had a lower EF (57 ± 5% vs. 62 ± 5%, P < 0.05). In an additional group of 33 patients, we compared the longitudinal dyssynchrony parameters as assessed by VVI and tissue Doppler imaging (TDI) and found them to be comparable. In conclusion, we find significant variation in time to peak velocities in subjects with no known cardiac disease, who had a normal left ventricular ejection fraction and QRS duration. VVI is comparable to TDI.

A Genome-Wide Methylation Study On Essential Hypertension In Young African American Males., Xiaoling Wang, Bonita Falkner, Haidong Zhu, Huidong Shi, Shaoyong Su, Xiaojing Xu, Ashok Kumar Sharma, Yanbin Dong, Frank Treiber, Bernard Gutin, Gregory Harshfield, Harold Snieder

Department of Medicine Faculty Papers

OBJECTIVE: There is emerging evidence from animal studies suggesting a key role for methylation in the pathogenesis of essential hypertension. However, to date, very few studies have investigated the role of methylation in the development of human hypertension, and none has taken a genome-wide approach. Based on the recent studies that highlight the involvement of inflammation in the development of hypertension, we hypothesize that changes in DNA methylation of leukocytes are involved in the pathogenesis of hypertension.

METHOD & RESULTS: We conducted a genome-wide methylation analysis on 8 hypertensive cases and 8 normotensive age-matched controls aged 14-23 years and performed …

Infective Endocarditis Epidemiology Over Five Decades: A Systematic Review., Leandro Slipczuk, J Nicolas Codolosa, Carlos D Davila, Abel Romero-Corral, Jeong Yun, Gregg S. Pressman, Vincent M. Figueredo

Division of Cardiology Faculty Papers

AIMS: To Assess changes in infective endocarditis (IE) epidemiology over the last 5 decades.

METHODS AND RESULTS: We searched the published literature using PubMed, MEDLINE, and EMBASE from inception until December 2011.

DATA FROM: Einstein Medical Center, Philadelphia, PA were also included. Criteria for inclusion in this systematic review included studies with reported IE microbiology, IE definition, description of population studied, and time frame. Two authors independently extracted data and assessed manuscript quality. One hundred sixty studies (27,083 patients) met inclusion criteria. Among hospital-based studies (n=142; 23,606 patients) staphylococcal IE percentage increased over time, with coagulase-negative staphylococcus (CNS) increasing over …

Periodontal Disease Is An Independent Predictor Of Intracardiac Calcification., Gregg S Pressman, Atif Qasim, Nitin Verma, Masami Miyamae, Kumiko Arishiro, Yasuhiro Notohara, Vitalie Crudu, Vincent M. Figueredo

Division of Cardiology Faculty Papers

BACKGROUND: Periodontitis is the most common chronic inflammatory condition worldwide and is associated with incident coronary disease.

HYPOTHESIS: We hypothesized that periodontal disease would also be associated with cardiac calcification, a condition which shares many risk factors with atherosclerosis and is considered a marker of subclinical atherosclerosis.

METHODS: Cross-sectional study at two sites (USA and Japan) involving subjects with both clinical echocardiograms and detailed dental examinations. Semiquantitative scoring systems were used to assess severity of periodontal disease and echocardiographic calcification.

RESULTS: Fifty-six of 73 subjects (77%) had cardiac calcifications, and 51% had moderate to severe periodontal disease (score > 2). In …