Medical Specialties Commons^™

Control Of Sars-Cov-2 Infection By Mt1-Mmp-Mediated Shedding Of Ace2, Xuanming Guo, Jianli Cao, Jian-Piao Cai, Jiayan Wu, Jiangang Huang, Pallavi Asthana, Sheung Kin Ken Wong, Zi-Wei Ye, Susma Gurung, Yijing Zhang, Sheng Wang, Zening Wang, Xin Ge, Hiu Yee Kwan, Aiping Lyu, Kui Ming Chan, Nathalie Wong, Jiandong Huang, Zhongjun Zhou, Zhao-Xiang Bian, Shuofeng Yuan, Hoi Leong Xavier Wong

Faculty, Staff and Student Publications

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. Angiotensin-converting enzyme 2 (ACE2) is an entry receptor for SARS-CoV-2. The full-length membrane form of ACE2 (memACE2) undergoes ectodomain shedding to generate a shed soluble form (solACE2) that mediates SARS-CoV-2 entry via receptor-mediated endocytosis. Currently, it is not known how the physiological regulation of ACE2 shedding contributes to the etiology of COVID-19 in vivo. The present study identifies Membrane-type 1 Matrix Metalloproteinase (MT1-MMP) as a critical host protease for solACE2-mediated SARS-CoV-2 infection. SARS-CoV-2 infection leads to increased activation of MT1-MMP that is colocalized with ACE2 in human lung …

Case Study: Abnormal Presentation Of Infective Endocarditis With Streptococcus Canis And Chiari Network, Shahbaz Afzal, Ryan Russell, Alexander Chekhov

Advances in Clinical Medical Research and Healthcare Delivery

Here we present a rare case of infective endocarditis (IE) with Streptococcus canis and Chiari network in an 85 year old female living with multiple dogs and open skin of lower extremity predisposing her to bacteremia. Underlying abnormalities of the cardiac chambers such as Chiari network predisposes to a higher incidence of bacterial seeding and causing IE. A Chiari network is usually asymptomatic and of no clinical significance but can worsen prognosis in IE. IE carries a significant morbidity and mortality burden and when diagnosed early can be a lifesaving diagnosis. Due to the wide range of complications, early diagnosis …

Total Transfemoral Percutaneous Endovascular Aortic Arch Repair Using 3-Vessel Inner Branch Stent-Graft, Emanuel R Tenorio, Thanila A Macedo, Laura Ocasio, Marina Dias Neto, Guilherme B Barbosa Lima, Aidin Baghbani-Oskouei, Anthony L Estrera, Abhijeet Dhoble, Shao Feng Zhou, Gustavo S Oderich

Faculty, Staff and Student Publications

Endovascular repair has been introduced to decrease the morbidity and mortality associated with open surgical repair of aortic arch pathology. We illustrate total percutaneous transfemoral approach with a 3-vessel inner branch stent-graft to treat aortic arch aneurysm. (Level of Difficulty: Advanced.).

Reflecting On The Advancements Of Hfref Therapies Over The Last Two Decades And Predicting What Is Yet To Come, Iliana L. Piña, Gregory T. Gibson, Shelley Zieroth, Rachna Kataria

Division of Cardiology Faculty Papers

What was once considered a topic best avoided, managing heart failure with reduced ejection fraction (HFrEF) has become the focus of many drug and device therapies. While the four pillars of guideline-directed medical therapies have successfully reduced heart failure hospitalizations, and some have even impacted cardiovascular mortality in randomized controlled trials (RCTs), patient-reported outcomes have emerged as important endpoints that merit greater emphasis in future studies. The prospect of an oral inotrope seems more probable now as targets for drug therapies have moved from neurohormonal modulation to intracellular mechanisms and direct cardiac myosin stimulation. While we have come a long …

Use Of Cardiomems Hf Sensor In Management Of Nyha Class Iii Heart Failure, Trevor Andrunik, Anne Eady

Physician Assistant Capstones, 2020-current

Objective: Assess the ability of continuous pulmonary artery pressure monitoring via implantable CardioMEMs HF device to reduce hospitalization in New York Heart Association (NYHA) Class III heart failure patients over the age of 18. Design: Systematic literature review. Methods: Searches were conducted via PubMed and ClinicalTrials.gov using the single search term “CardioMEMs.” Inclusion criteria narrowed results to studies performed in the last 10 years, randomized control trials, cohort studies, and utilizing heart failure related hospitalization as the primary endpoint. Results: The current data unanimously asserts that the CardioMEMs HF device is effective at reducing heart failure related hospitalizations, with secondary …

Advancing Global Equity In Cardiac Care As Cardiac Implantable Electronic Device Reuse Comes Of Age, Daniel Alyesh, Behzad B. Pavri, William Choe, Mam Chandara, Mahmoud U. Sani, Phong Dinh Phan, Aime Bonny, Paul Khairy, Sunil K. Sinha, Uma Srivatsa, Joseph E. Marine, Kim Eagle, Thomas C. Crawford, Dhanunjaya Lakkireddy, Sri Sundaram

Division of Cardiology Faculty Papers

A nation’s health and economic development are inextricably and synergistically connected. Stark differences exist between wealthy and developing nations in the use of cardiac implantable electronic devices (CIEDs). Cardiovascular disease is now the leading cause of death in low- and middle-income countries (LMIC), with a significant burden from rhythm-related diseases. As science, technology, education, and regulatory frameworks have improved, CIED recycling for exportation and reuse in LMIC has become possible and primed for widespread adoption. In our manuscript, we outline the science and regulatory pathways regarding CIED reuse. We propose a pathway to advance this technology that includes creating a …

Frailty Determination And Responsiveness In Left Ventricular Assist Devices, Sarah Schroeder

Theses & Dissertations

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD …

Cardiac Conditions, Ana Paula Coelho Figueira Freire, Mark R. Elkins

All Faculty Scholarship for the College of Education and Professional Studies

This Editorial introduces another of Journal of Physiotherapy’s article collections.These are collections of papers on a particular topic, published in the Journal of Physiotherapy within the past decade and compiled to: facilitate access to important recent findings on the topic; highlight trends in research designs, methods, populations and interventions; and suggest avenues for further research. The studies in this article collection relate to physiotherapy management of cardiac conditions.

Association Of Sepsis-Induced Cardiomyopathy And Mortality: A Systematic Review And Meta-Analysis, Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus D. Melgarejo, Zhen-Yu Zhang, Chia-Te Liao

School of Medicine Publications

Background

The implication of sepsis-induced cardiomyopathy (SIC) to prognosis is controversial, and its association with mortality at different stages remains unclear. We conducted a systematic review and meta-analysis to understand the association between SIC and mortality in septic patients.

Methods

We searched and appraised observational studies regarding the mortality related to SIC among septic patients in PubMed and Embase from inception until 8 July 2021. Outcomes comprised in-hospital and 1-month mortality. We adopted the random-effects model to examine the mortality risk ratio in patients with and without SIC. Meta-regression, subgroup, and sensitivity analyses were applied to examine the outcome’s heterogeneity. …

Clinical Characteristics And Electrophysiologic Properties Of Scn5a Variants In Fever-Induced Brugada Syndrome, Gan-Xiao Chen, Hector Barajas-Martinez, Giuseppe Ciconte, Cheng-I Wu, Michelle M Monasky, Hao Xia, Bian Li, John A Capra, Kai Guo, Zhong-He Zhang, Xiu Chen, Bo Yang, Hong Jiang, Gary Tse, Chloe Miu Mak, Yoshiyasu Aizawa, Michael H Gollob, Charles Antzelevitch, Arthur A M Wilde, Carlo Pappone, Dan Hu

Division of Cardiology Faculty Papers

Background: Brugada syndrome (BrS) is a severe inherited arrhythmia syndrome that can be unmasked by fever.

Methods: A multicentre clinical analysis was performed in 261 patients diagnosed with fever-induced BrS, including 198 (75.9%) and 27 (10.3%) patients who received next-generation genetic sequencing and epicardial arrhythmogenic substrate (AS) mapping, respectively.

Findings: In fever-induced BrS patients, pathogenic or likely pathogenic (P/LP) SCN5A variant carriers developed fever-induced BrS at a younger age, and more often in females and those of Caucasian descent. They exhibited significant electrophysical abnormalities, including a larger epicardial AS area, and more prolonged abnormal epicardial electrograms. During a median follow-up …

Intercellular Communication Via Gap Junctions Influences Cell Survival During Hypoxia, Lauren E. Harmon, David L. Geenen

Student Summer Scholars Manuscripts

Stem cell therapy can be beneficial following myocardial infarction. However, when murine bone marrow-derived mesenchymal stem cells (mBM-MSCs) are injected into the ischemic area, a large percentage of these cells undergo apoptosis resulting in decreased therapeutic benefits. We hypothesize that the loss of these mBM-MSCs is regulated by intercellular channels or gap junctions (GJs) that provide apoptotic signals passed between ischemic cardiomyocytes and mBM-MSCs. Our research aims to attenuate these GJs by suppressing Connexin-43 (Cx43) expression, the predominant channel-forming protein. We will accomplish this by transiently transfecting a Cx43 siRNA into mBM-MSCs. Our data demonstrate that intracellular fluorescent dyes and …

Methylprednisolone For Heart Surgery In Infants - A Randomized, Controlled Trial, Kevin D Hill, Prince J Kannankeril, Jeffrey P Jacobs, H Scott Baldwin, Marshall L Jacobs, Sean M O'Brien, David P Bichel, Eric M Graham, Brian Blasiole, Ashraf Resheidat, Adil S Husain, S Ram Kumar, Jerry L Kirchner, Dianne S Gallup, Joseph W Turek, Mark Bleiweis, Bret Mettler, Alexis Benscoter, Eric Wald, Tara Karamlou, Andrew H Van Bergen, David Overman, Pirooz Eghtesady, Ryan Butts, John S Kim, John P Scott, Brett R Anderson, Michael F Swartz, Patrick I Mcconnell, David F Vener, Jennifer S Li, Stress Network Investigators

Faculty, Staff and Students Publications

BACKGROUND: Although perioperative prophylactic glucocorticoids have been used for decades, whether they improve outcomes in infants after heart surgery with cardiopulmonary bypass is unknown.

METHODS: We conducted a multicenter, prospective, randomized, placebo-controlled, registry-based trial involving infants (age) undergoing heart surgery with cardiopulmonary bypass at 24 sites participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database. Registry data were used in the evaluation of outcomes. The infants were randomly assigned to receive prophylactic methylprednisolone (30 mg per kilogram of body weight) or placebo, which was administered into the cardiopulmonary-bypass pump-priming fluid. The primary end point was a ranked composite …

Partial Outpatient Oral Antibiotic Treatment Of Infective Endocarditis Is Non-Inferior To Inpatient Intravenous Antibiotic Therapy, Nicholas J. Murphy

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Iversen K, Ihlemann N, Gill SU, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019; 380:415-424. https://doi.org/10.1056/NEJMoa1808312

for a patient with infective endocarditis and intravenous drug use with desire to leave the hospital.

Unfavorable Social Determinants Of Health Are Associated With Higher Burden Of Financial Toxicity Among Patients With Atherosclerotic Cardiovascular Disease In The Us: Findings From The National Health Interview Survey, Javier Valero-Elizondo, Zulqarnain Javed, Rohan Khera, Mauricio E. Tano, Ramzi Dudum, Isaac Acquah, Adnan A. Hyder, Julia Andrieni, Garima Sharma, Salim S. Virani

Office of the Provost

Background: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of financial toxicity, defined as excess financial strain from healthcare, in the US. Identifying factors that put patients at greatest risk can help inform more targeted and cost-effective interventions. Specific social determinants of health (SDOH) such as income are associated with a higher risk of experiencing financial toxicity from healthcare, however, the associations between more comprehensive measures of cumulative social disadvantage and financial toxicity from healthcare are poorly understood.
Methods: Using the National Health Interview Survey (2013-17), we assessed patients with self-reported ASCVD. We identified 34 discrete SDOH items, across 6 …

Glucocentric Drugs In Cardiovascular Disease Protection And Heart Failure, Khawaja M. Talha, Gregg C. Fonarow, Salim S. Virani, Javed Butler

Office of the Provost

Evidence for cardiovascular outcomes with older-generation antihyperglycemic drugs in the management of type 2 diabetes is based on aggregated data from prior randomized controlled trials and observational studies that were not focused on prespecified cardiovascular end points. Newer antihyperglycemic medications have undergone a rigorous evaluation of cardiovascular outcomes through randomized controlled trials since the US Food and Drug Administration imposed a mandatory requirement for all glucose-lowering drugs in 2008. The three classes of drugs that have been most extensively studied are dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors, the latter two reporting significant …

A Unified Model Of Age-Related Cardiovascular Disease, Michael Fossel, Joe Bean, Nina Khera, Mikhail G Kolonin

Faculty, Staff and Student Publications

Despite progress in biomedical technologies, cardiovascular disease remains the main cause of mortality. This is at least in part because current clinical interventions do not adequately take into account aging as a driver and are hence aimed at suboptimal targets. To achieve progress, consideration needs to be given to the role of cell aging in disease pathogenesis. We propose a model unifying the fundamental processes underlying most age-associated cardiovascular pathologies. According to this model, cell aging, leading to cell senescence, is responsible for tissue changes leading to age-related cardiovascular disease. This process, occurring due to telomerase inactivation and telomere attrition, …

Unfavorable Social Determinants Of Health Are Associated With Higher Burden Of Financial Toxicity Among Patients With Atherosclerotic Cardiovascular Disease In The Us: Findings From The National Health Interview Survey, Javier Valero-Elizondo, Zulqarnain Javed, Rohan Khera, Mauricio E Tano, Ramzi Dudum, Isaac Acquah, Adnan A Hyder, Julia Andrieni, Garima Sharma, Michael J Blaha, Salim S Virani, Ron Blankstein, Miguel Cainzos-Achirica, Khurram Nasir

Faculty, Staff and Students Publications

• D: PMC9727868

Saudi Heart Association Guidelines On Best Practices In The Management Of Chronic Coronary Syndromes, Owayed Alshammeri, Shukri Al Saif, Halia Al Shehri, Mirvat Alasng, Fatema Qaddoura, Mohammad Al Shehri, Yosra Turkistani, Adel Tash, Walid Alharbi, Fahad Al Qahtani, Rafael Diaz, Wael Mahaimeed, Waleed Al Habeeb, Khalid Alfaraidy

Journal of the Saudi Heart Association

Background: The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel: A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings: Recommendations are provided …

There's A Hole In My Heart: A Case Of An Unrepaired Vsd, Brittany Hartman, Alex Dwyer, Robert Dejoy

Einstein Health Papers

No abstract provided.

Coronary Artery Calcium Score On Standard Of Care Oncologic Ct Scans For The Prediction Of Adverse Cardiovascular Events In Patients With Non-Small Cell Lung Cancer Treated With Concurrent Chemoradiotherapy, Efstratios Koutroumpakis, Ting Xu, Juan Lopez-Mattei, Tinsu Pan, Yang Lu, Jorge A Irizarry-Caro, Radhe Mohan, Xiaodong Zhang, Qing H Meng, Ruitao Lin, Tianlin Xu, Anita Deswal, Zhongxing Liao

Faculty, Staff and Student Publications

INTRODUCTION: Chemoradiotherapy (CRT) has been associated with increased incidence of cardiovascular (CV) adverse events (CVAE). Coronary artery calcium scoring (CAC) has shown to predict coronary events beyond the traditional CV risk factors. This study examines whether CAC, measured on standard of care, non-contrast chest CT (NCCT) imaging, predicts the development of CVAE in patients with non-small cell lung cancer (NSCLC) treated with CRT.

METHODS: Patients with NSCLC treated with CRT at MD Anderson Cancer Center from 7/2009 until 4/2014 and who had at least one NCCT scan within 6 months from their first CRT were identified. CAC scoring was performed …

Why Is Epinephrine Not The Drug Of Choice In Cardiogenic Shock?, Esther Vorovich

Journal of Shock and Hemodynamics

Through the years, epinephrine has been the drug of choice for patients with cardiogenic shock. However, epinephrine was clinically inferior to norepinephrine in comparison studies because of the negative patient outcomes, which were statistically significant. These effects include type B lactic acidosis, tachycardia, increased myocardial oxygen demand, and arrhythmias.

Profound Vasoplegia After Coronary Artery Bypass Grafting, Subhasis Chatterjee

Journal of Shock and Hemodynamics

Vasoplegic shock after cardiac surgery is characterized by a high cardiac output, low systemic vascular resistance, refractory hypotension, and ongoing need for vasopressors. In this case, management considerations are discussed, including vasoactive medications and other adjuncts to sustain a satisfactory mean arterial pressure and improve outcomes.

Reperfusion Injury In Acute Myocardial Infarction Shock- Role Of Mechanical Circulatory Support Devices, Finn Gustafsson

Journal of Shock and Hemodynamics

The efficacy of mechanical circulatory support in acute myocardial infarction is dependent upon the size of the infarct. If applied early, mechanical support to reduce reperfusion injury appears to be effective in reducing infarct size in animal studies. The optimal timing of reperfusion is uncertain and requires further investigation. Efficient unloading appears to be essential in increasing the efficacy of the type of mechanical support and may favor one over another.

Racial Variations In Shock Presentation And Outcome, Steven Bailey

Journal of Shock and Hemodynamics

Working toward inclusive strategies for data sampling, trials, and triage is essential. Whatever the approach, it is important to do better than what has been done in the past when considering race and ethnicity in patient care. Although there may be limited publications with information on this topic, they have shown clear differences in patient outcomes with possible associations with gender, race, and ethnicity. It is critical to view the implications of this on socioeconomic status, access, resources, patient phenotypes, and patient desires and expectations. The disparities must first be recognized before any treatment options can be identified.

Hemodynamic Goals In Shock Management: Is There One Target For All?, Maya Guglin

Journal of Shock and Hemodynamics

The current guidelines for managing cardiogenic shock lack specificity and clarification. The main criterion for cardiogenic shock is low cardiac output, and the most important goal is to achieve adequate output from a shock state. Because of the complex nature of cardiogenic shock, a “one-size-fits-all" outline may not be the best solution. Historically, hemodynamic goals in cardiogenic shock are copied from septic shock. Because septic shock and cardiogenic shock are different hemodynamic entities, the goals should be different.

Hemodynamics And Kinetics Of Heart Failure With Preserved Ejection Fraction Shock, Yevgeniy Brailovsky, J. Eduardo Rame, Thierry Le Jemtel, Indranee Rajapreyar

Journal of Shock and Hemodynamics

The classical paradigm of cardiogenic shock is severe impairment of left ventricular, right ventricular, or biventricular contractility resulting in decreased cardiac output and end-organ failure. In patients with preserved ejection fraction, cardiogenic shock results from impaired left ventricular filling leading to decreased cardiac output and end-organ hypoperfusion. Heart failure with preserved ejection fraction (HFpEF) comprises a heterogenous group of myocardial and systemic metabolic derangements. Cardiogenic shock with preserved left ventricular ejection is thought to be less common than with reduced left ventricular ejection fraction, and therapeutic approaches are not well standardized. We aim to review the pathophysiology of cardiogenic shock …

Strategies For Reducing Vascular And Bleeding Risk For Percutaneous Left Ventricular Assist Device-Supported High-Risk Percutaneous Coronary Intervention, George W. Vetrovec, Amir Kaki, Jason Wollmuth, Thom G. Dahle Md

Articles

In patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impella-supported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural …

Effectiveness Of Non-Invasive Respiratory Support Strategies In Patients With Covid-19: A Systematic Review And Meta Analysis, Vinesh Kumar, Umair Arshad Malik, Reshman Kumari, Berkha Berkha, Vijay Kumar, Manoj Kumar, Simran Simran, Suman Suman, Bushra Nasim

Medical College Documents

Background: The effectiveness of non-invasive respiratory strategies, namely CPAP and HFNO, in reducing the risk of mortality and tracheal intubation in patients with severe COVID-19 is not well established.
Methods: A thorough literature search was conducted across 3 electronic databases (Medline, EMBASE and Cochrane Central) from inception through July 2022. Randomized controlled trials (RCTs) and observational studies assessing the impact of CPAP or HFNO on clinical outcomes in patients infected with COVID-19 were considered for inclusion. End-points included all-cause mortality and risk of tracheal intubation. Evaluations were reported as risk ratios (RRs) with 95% confidence intervals (CI) and analysis was …

Strong Structuration Analysis Of Patterns Of Adherence To Hypertension Medication, Maureen L. Seguin, Jhaki A. Mendoza, Gideon Lasco, Lia M. Palileo-Villanueva, Benjamin Palafox, Alicia Renedo, Martin Mckee, Dina Balabanova

Development Studies Faculty Publications

Achieving blood pressure control is among the highest priorities for reducing the burden of cardiovascular diseases globally. Control is poor in the Philippines; especially in socioeconomically marginalised communities. This paper explores long-term adherence to anti-hypertensive medication in these communities; identifying 4 distinct medication adherence patterns. We draw on Strong Structuration Theory to explore motivations of action for those who are consistently adherent; consistently non-adherent; and those who became more or less adherent over time. We employ longitudinal qualitative methods comprising repeat interviews and digital diaries collected over 12 months by 34 participants. Twelve participants were consistently adherent; 9 consistently non-adherent; …

Barriers And Facilitators In Implementing Multiplatform Remote Patient Monitoring Of Heart Failure Patients In Clinical Settings, Zachary Andrew Reilly

All Theses

Remote patient monitoring (RPM), which provides continuous monitoring of vital signs, has become increasingly utilized in patients with heart failure (HF). As this condition impacts more than 26 million Americans each year, it is important to determine the barriers and facilitators of RPM to both improve patient care and help medical professionals make more informed medical decisions. To determine these barriers and facilitators, our research team partnered with Prisma Health-Upstate to interview healthcare professionals working at Carolina Cardiology Consultants--Greenville, which uses multiple RPM systems to monitor heart failure patients.

The twelve interviews conducted support that healthcare professionals would benefit from …