Medical Specialties Commons^™

Nuclear Receptor Subfamily 4 Group A Member 2 Inhibits Activation Of Erk Signaling And Cell Growth In Response To Β-Adrenergic Stimulation In Adult Rat Cardiomyocytes, Sadia Ashraf, Yassmin K Hegazy, Romain Harmancey

Faculty, Staff and Student Publications

Sustained elevation of sympathetic activity is an important contributor to pathological cardiac hypertrophy, ventricular arrhythmias, and left ventricular contractile dysfunction in chronic heart failure. The orphan nuclear receptor NR4A2 is an immediate early-response gene activated in the heart under β-adrenergic stimulation. The goal of this study was to identify the transcriptional remodeling events induced by increased NR4A2 expression in cardiomyocytes and their impact on the physiological response of those cells to sustained β-adrenergic stimulation. Treatment of adult rat ventricular myocytes with isoproterenol induced a rapid (<4 >h) increase in NR4A2 levels that was accompanied by a transient (<24 >h) increase …

Mechanisms Of Simvastatin Myotoxicity: The Role Of Autophagy Flux Inhibition., Arya Emami, Shahla Shojaei, Simone C. Da Silva Rosa, Mahmoud Aghaei, Ehsan Samiei, Amir Reza Vosoughi, Forouh Kalantari, Philip Kawalec, James Thliveris, Pawan Sharma, Amir A. Zeki, Mohsen Akbari, Joseph W. Gordon, Saeid Ghavami

Center for Translational Medicine Faculty Papers

Statins are some of the most widely used drugs worldwide, but one of their major side effects is myotoxicity. Using mouse myoblast (C2C12) and human alveolar rhabdomyosarcoma cell lines (RH30) in both 2-dimensional (2D) and 3-dimensional (3D) cell culture, we investigated the mechanisms of simvastatin's myotoxicity. We found that simvastatin significantly reduced cell viability in C2C12 cells compared to RH30 cells. However, simvastatin induced greater apoptosis in RH30 compared to C2C12 cells. Simvastatin-induced cell death is dependent on geranylgeranyl pyrophosphate (GGPP) in C2C12 cells, while in RH30 cells it is dependent on both farnesyl pyrophosphate (FPP) and GGPP. Simvastatin inhibited …

Coronary Heart Disease, Hypertension And Use Of Biomass Fuel Among Women: Comparative Cross-Sectional Study, Zafar Fatmi, Georgia Ntani, David Coggon

Community Health Sciences

Objectives: To explore the associations of hypertension and coronary heart disease (CHD) with use of biomass fuel for cooking.
Design: Comparative cross-sectional study.
Setting: Rural villages in Sindh, Pakistan.
Participants: Women aged ≥40 years who had used biomass fuel for cooking for at least the last year (n=436), and a comparison group (n=414) who had cooked only with non-biomass fuel during the last year were recruited through door-to-door visits. None of those who were invited to take part declined.
Primary and secondary outcome measures: Hypertension was determined from blood pressure measurements and use of medication. CHD was assessed by three …

Electromechanical Dyssynchrony And Clinically Silent Ventricular Dysfunction In Young Subjects With Ventricular Pacing For Congenital And Early Acquired Av Block, Daniel Forsha, David G. Gamboa, Niels Risum, Andrea Kropf, Christoph P. Hornik, Piers Barker, Joseph Kisslo, Ronald J. Kanter

Manuscripts, Articles, Book Chapters and Other Papers

Purpose: Single site ventricular pacing can result in electromechanical dyssynchrony and LV dysfunction. A classic pattern by strain echocardiography pattern analysis has been defined that specifically identifies electromechanical dyssynchrony that leads to LV dysfunction in other populations. Our purpose is to evaluate for the presence of the classic pattern and an association with LV dysfunction in asymptomatic young subjects with chronic pacing.

Methods: Inclusion criteria of non-surgical 2nd or 3rd degree AV block, normal cardiac anatomy, chronic ventricular pacing (> 95% of beats) and a quality 4-chamber apical image were met by 24 retrospective and 10 prospectively enrolled subjects. Global …

Developing An Evidence-Based Discharge Process For Patients On A Cardiac/Renal Acuity-Adaptable Inpatient Unit, Tami Gallagher

Master's Projects

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase.

Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%.

Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness …

Advances In Structural Heart Disease: Mitraclip For Secondary Mitral Regurgitation - A Potential Game Changer, Shahrukh Hashmani, Amammarah Yasmeen, Shayana Rukhsar Hashman

Section of Cardiology

No abstract provided.

Severity Of Chest Pain Among Acute Myocardial Infarction Patients With Diagonal Branch Vessel Disease: A Pilot Study, Nasir Rahman, Azmina Artani, Farhala Mari Baloch, Bilal Hussain

Section of Cardiology

Introduction: Acute myocardial infarction (AMI) patients present with variable clinical manifestations such as shortness of breath, nausea, etc. among which chest pain is the most common. Previous studies have reported that the clinical presentation of AMI patients with branch vessel disease is indistinguishable from epicardial coronary vessel disease. However, our experience suggests patients with branch vessel disease experience severe chest pain, especially those with a diagonal branch. Therefore, we aim to study the association of chest pain severity with isolated diagonal branch vessel disease as a culprit vessel in AMI patients.

Methods: It is a retrospective case-control design, where 10 …

Frequency Of Peri-Operative Hypertension In A Tertiary Care Hospital In Karachi, Pakistan, Momena Sohail, Aysha Almas, Ayesha Majeed Memon, Bushra Usmani, Aamir Hameed, G. Afshan

Section of Internal Medicine

This study aims to determine the frequency of perioperative hypertension and its types (pre, intra and post-operative) hypertension in patients admitted for surgical procedures. This was a cross-sectional study conducted between the years 2012-2013 at the Aga Khan University Hospital, Karachi. Patients admitted for any surgical procedure during this time were included. Perioperative hypertension has been defined as systolic blood pressure of >140 mm Hg or a diastolic blood pressure of >90 mm Hg or whose blood pressure increased by 20% during surgery. A total of 428 surgical procedures were reviewed for the study. Overall perioperative hypertension was present in …

Microbial Colonization Of Pneumatic Tourniquets In The Orthopedic Operating Room, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Rizwan Haroon Rashid, Bilal Ahmed, Seema Irfan, Akbar Jaleel Zubair, Shahryar Noordin

Section of Orthopaedic Surgery

Background: The rate of surgical site infections following orthopedic procedures is approximately 2% globally. Potential sources of contamination in the operating room include pneumatic tourniquets, blood pressure cuffs, and stethoscopes, among others. Our study aims to investigate microbial colonization on reusable pneumatic tourniquets stored and used in the orthopedic department of our institution and evaluate the efficacy of the cleaning protocols employed. Methods: Over a course of two weeks, 26 samples were obtained. A total of 14 pneumatic tourniquets were sampled preoperatively on Monday morning following the weekly cleaning protocol of soaking the tourniquets in sodium hypochlorite for 30 minutes …

Prasugrel Inappropriate Use In Patients Post-Percutaneous Coronary Intervention (Pci). A Single Center Study, Ahmed Amro, Kanaan Mansoor, Mohammad Amro, Amal Sobeih, Obadah Aqtash, Hisham Hirzallah, Alaa Gabi, Madhulika Urella, Waseem Ahmed, Sandra Shenouda, Dr. Rameez Sayyed, Md

Marshall Journal of Medicine

Prasugrel is a thienopyridine that was approved by the US Food and Drug Administration (FDA) in combination with aspirin for the reduction of thrombotic events as well as stent thrombosis in patients with ACS who undergo PCI. This retrospective study aims to assess the frequency of inappropriate use of prasugrel and to emphasize that prasugrel still needs more attention as inappropriate use may result in significant morbidity.

Functionalization Of Cd36 Cardiovascular Disease And Expression Associated Variants By Interdisciplinary High Throughput Analysis., Namrata Madan, Andrew R. Ghazi, Xianguo Kong, Edward S. Chen, Chad A. Shaw, Leonard C. Edelstein

Department of Medicine Faculty Papers

CD36 is a platelet membrane glycoprotein whose engagement with oxidized low-density lipoprotein (oxLDL) results in platelet activation. The CD36 gene has been associated with platelet count, platelet volume, as well as lipid levels and CVD risk by genome-wide association studies. Platelet CD36 expression levels have been shown to be associated with both the platelet oxLDL response and an elevated risk of thrombo-embolism. Several genomic variants have been identified as associated with platelet CD36 levels, however none have been conclusively demonstrated to be causative. We screened 81 expression quantitative trait loci (eQTL) single nucleotide polymorphisms (SNPs) associated with platelet CD36 expression …

Symmetrical Peripheral Gangrene Associated With Low Output Cardiac Failure., Sijan Basnet, Priya Rajagopalan, Rashmi Dhital, Ataul Qureshi

Department of Medicine Faculty Papers

Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.

Symmetrical Peripheral Gangrene Associated With Low Output Cardiac Failure., Sijan Basnet, Priya Rajagopalan, Rashmi Dhital, Ataul Qureshi

Reading Hospital Internal Medicine Residency

Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.

A Community-Wide Collaboration To Reduce Cardiovascular Disease Risk: The Hearts Of Sonoma County Initiative., Allen Cheadle, Michelle Rosaschi, Dolores Burden, Monica Ferguson, Bo Greaves, Lori Houston, Jennifer Mcclendon, Jerome Minkoff, Maggie Jones, Pam Schwartz, Jean Nudelman, Mary Maddux-Gonzalez

Articles, Abstracts, and Reports

PURPOSE AND OBJECTIVES: Collaboration across multiple sectors is needed to bring about health system transformation, but creating effective and sustainable collaboratives is challenging. We describe outcomes and lessons learned from the Hearts of Sonoma County (HSC) initiative, a successful multi-sector collaborative effort to reduce cardiovascular disease (CVD) risk in Sonoma County, California.

INTERVENTION APPROACH: HSC works in both clinical systems and communities to reduce CVD risk. The initiative grew out of a longer-term county-wide collaborative effort known as Health Action. The clinical component involves activating primary care providers around management of CVD risk factors; community activities include community health workers …

Navigating A Difficult Transition In Pulmonary Arterial Hypertension: A Clinical Case Study, Tina Hyman, Michael Salinero, Francisco Javier Jimenez-Carcamo, Margarita Pallares, Maribel Matos

Nursing & Health Sciences Research Journal

Over the past 20 years, Pulmonary Arterial Hypertension (PAH) patients and providers have seen an increase in options to treat PAH. Currently, there are choices for the delivery of medications approved to treat patients with PAH where at one point the only option was intravenous (IV) therapy. This case study details the transition from IV Epoprostenol to oral Treprostinil for the treatment of a 53 year old female diagnosed with severe Pulmonary Arterial Hypertension whose quality of life became unbearable by the IV medication delivery route. This patient was a synchronized swimmer in her youth and her passion for water …

Implanting Loop Recorders In A Hospital Unit Versus The Electrophysiology Laboratory: A Retrospective Chart Review, Marie Paule Lafontant, Valerie E. Smith, Nohemi Sadule Rios, Marsha Camille Lambert

Nursing & Health Sciences Research Journal

Introduction: Cardiac arrhythmias and unexplained syncopal episodes remain a challenge for clinicians to diagnose. The recent creation of the smallest Implantable Loop Recorder (ILR) assists in identifying the causes behind cardiac and neurological events. The current study aimed to compare the practice of implanting loop recorders at the bedside in the Cardiac and Vascular Care Unit (CVCU) to implantations in the Electrophysiology Laboratory (EP Lab).

Methods: This study was a retrospective review of electronic medical records. Data abstraction included implantation dates, time of admission and discharge, length of stay (LOS), number of healthcare staff involved, and cost of the procedure. …

Provider-Level Variation In Smoking Cessation Assistance Provided In The Cardiology Clinics: Insights From The Ncdr Pinnacle Registry, Mayank Sardana, Yuanyuan Tang, Jared W. Magnani, Ira S. Ockene, Jeroan J. Allison, Suzanne V. Arnold, Phillip G. Jones, Thomas M. Maddox, Salim S. Virani, David D. Mcmanus

Office of the Provost

Background: Studies show suboptimal provision of smoking cessation assistance (counseling or pharmacotherapy) for current smokers attempting to quit. We aimed to identify smoking cessation assistance patterns in US cardiology practices.
Methods and Results: Among 328 749 current smokers seen between January 1, 2013, and March 31, 2016, in 348 NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence)‐affiliated cardiology practices, we measured the rates of cessation assistance. We used multivariable hierarchical logistic regression models to determine provider‐, practice‐, and patient‐level predictors of cessation assistance. We measured provider variation in cessation assistance using median rate ratio (the likelihood that …

A Comparison Of The Accuracy Of Watchman Device Sizing Between Ct, Tee And Patient Specific 3d Models, Luke Matthew Landrigan Md, John Lozo, T. Eric White Md, Emily Keltner Bs, Ma

Parkview Heart Institute

Poster Presented at Conference: Indiana University Student Education and Research Fellowship Program

Objective: Determine the accuracy and reliability of CT imaging and CT-based patient specific 3D models of the left atrial appendage for the preprocedural planning of WATCHMAN device implantation in comparison to TEE

Evidence-Based Cardiac Monitoring: A Practice Change, Joseph Paul Urbanski

Doctoral Projects

Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM.

Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units …

Comparison Of Cyanoacrylate Closure And Radiofrequency Ablation For The Treatment Of Incompetent Great Saphenous Veins: 36-Month Outcomes Of The Veclose Randomized Controlled Trial., Nick Morrison, Raghu Kolluri, Michael Vasquez, Monte Madsen, Andrew Jones, Kathleen Gibson

Heart and Vascular Articles

OBJECTIVE: To evaluate the 36-month efficacy and safety of cyanoacrylate closure for the treatment of incompetent great saphenous veins in comparison with radiofrequency ablation.

METHODS: In this multicenter, prospective, randomized controlled trial, 222 symptomatic subjects with incompetent great saphenous veins were assigned to either cyanoacrylate closure or radiofrequency ablation. The primary endpoint, complete closure of the target great saphenous vein, was determined using duplex ultrasound examination starting from three-month visit.

RESULTS: At month 36, the great saphenous vein closure rates were 94.4% for the cyanoacrylate closure group and 91.9% for the radiofrequency ablation group. Stable improvement in symptoms and quality …

Phospholipases D: Making Sense Of Redundancy And Duplication, Andrew J. Morris

Internal Medicine Faculty Publications

Why have two genes when one would suffice? Evolutionary pressure means that biology, unlike government, is generally intolerant of wasted effort. Therefore, when multiple genes exist presumably they are there to provide some benefit to the organism even if that benefit is not immediately obvious to us scientists. A recent report from Raghu and colleagues (Biosci. Rep. (2018) 38, pii: BSR20181690) [1] sheds some light on one possible reason for the existence of two Phospholipases D genes in chordates when only one is present in invertebrates.

Prognostic Role Of Elevated Myeloperoxidase In Patients With Acute Coronary Syndrome: A Systemic Review And Meta-Analysis, Andrew R. Kolodziej, Mohamed Abo-Aly, Eman Elsawalhy, Charles Campbell, Khaled M. Ziada, Ahmed K. Abdel-Latif

Gill Heart & Vascular Institute Faculty Publications

Background. Myocardial inflammation following acute ischemic injury has been linked to poor cardiac remodeling and heart failure. Many studies have linked myeloperoxidase (MPO), a neutrophil and inflammatory marker, to cardiac inflammation in the setting of acute coronary syndrome (ACS). However, the prognostic role of MPO for adverse clinical outcomes in ACS patients has not been well established. Methods. MEDLINE and Cochrane databases were searched for studies from 1975 to March 2018 that investigated the prognostic value of serum MPO in ACS patients. Studies which have dichotomized patients into a high MPO group and a low MPO group reported clinical outcomes …

Ethnic And Gender Disparities In The Uptake Of Transcatheter Aortic Valve Replacement In The United States, Ayman Elbadawi, Syed Yaseen Naqvi, Islam Y. Elgendy, Mohamed F. Almahmoud, Mohamed Hamed, Hesham Abowali, Gbolahan O. Ogunbayo, Hani Jneid, Khaled M. Ziada

Internal Medicine Faculty Publications

Introduction: Little is known about ethnic and gender disparities for transcatheter aortic valve replacement (TAVR) procedures in the United States.

Methods: We queried the Nationwide Inpatient Sample (NIS) database (2011–2014) to identify patients who underwent TAVR. We described the temporal trends in the uptake of TAVR procedures among various ethnicities and genders.

Results: Our analysis identified 39,253 records; 20,497 (52.2%) were men and 18,756 (47.8%) were women. Among all TAVRs, 87.2% were Caucasians, 3.9% were African Americans (AA), 3.7% were Hispanics, and 5.2% were of other ethnicities. We found a significant rise in the trend of TAVRs in all groups: …

Pathologic Gene Network Rewiring Implicates Ppp1r3a As A Central Regulator In Pressure Overload Heart Failure., Pablo Cordero, Victoria N Parikh, Elizabeth T Chin, Ayca Erbilgin, Michael J Gloudemans, Ching Shang, Yong Huang, Alex C Chang, Kevin S Smith, Frederick Dewey, Kathia Zaleta, Michael Morley, Jeff Brandimarto, Nicole Glazer, Daryl Waggott, Aleksandra Pavlovic, Mingming Zhao, Christine S Moravec, W H Wilson Tang, Jamie Skreen, Christine Malloy, Sridhar Hannenhalli, Hongzhe Li, Scott Ritter, Mingyao Li, Daniel Bernstein, Andrew Connolly, Hakon Hakonarson, Aldons J Lusis, Kenneth B Margulies, Anna A Depaoli-Roach, Stephen B Montgomery, Matthew T Wheeler, Thomas Cappola, Euan A Ashley

Articles, Abstracts, and Reports

Heart failure is a leading cause of mortality, yet our understanding of the genetic interactions underlying this disease remains incomplete. Here, we harvest 1352 healthy and failing human hearts directly from transplant center operating rooms, and obtain genome-wide genotyping and gene expression measurements for a subset of 313. We build failing and non-failing cardiac regulatory gene networks, revealing important regulators and cardiac expression quantitative trait loci (eQTLs). PPP1R3A emerges as a regulator whose network connectivity changes significantly between health and disease. RNA sequencing after PPP1R3A knockdown validates network-based predictions, and highlights metabolic pathway regulation associated with increased cardiomyocyte size and …

Low Voltage Criteria Ekg As A Harbinger Of Systemic Disease., Ian Garrahy, Daniel Forman, Sharon Swierczynski

Reading Hospital Internal Medicine Residency

AL amyloidosis is due to deposition of protein derived from immunoglobulin light chain fragments. It is a systemic disorder in which deposition of plasma proteins can adversely affect function of the heart, liver, kidneys, and peripheral nerves. Deposition in the heart results in a decrease in the amplitude of the electrical activity of the heart and can be an early clue to the diagnosis. A 63-year-old male admitted for volume overload was found to have nephrotic range proteinuria, progressive renal insufficiency (Creatinine 4.0 increased from his baseline 0.9), and hypoalbuminemia. On exam, he had diffuse anasarca and peripheral neuropathy. A …

Heart Failure With Preserved Ejection Fraction: A Review Of The Acc/Aha Guidelines And Evidence-Based Management Strategy, Vikas Sunder, Md

The Medicine Forum

Introduction

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which a patient has signs and symptoms of heart failure including dyspnea, fatigue, pulmonary rales, peripheral edema and an ejection fraction greater than 50%.1-4 Approximately half of patients with heart failure have a preserved ejection fraction.2-5 HFpEF is considered a distinct clinical entity from other causes of heart failure with a preserved ejection fraction such as valvular heart disease, pericardial disease, and infiltrative cardiomyopathy. HFpEF carries a poor prognosis, with an annual mortality of 29% in patients discharged after an acute decompensated heart failure admission.5 5-year survival …

Can Our Hearts Take The New Guidelines?, Eitan Frankel, Md

The Medicine Forum

No abstract provided.

The Use Of Cardiomems In Dialysis Patients With Heart Failure, Karolina Viquez, Peggy Hardesty, Karim Fahmy, Amr Elhusseini, Mohamed Elyamny, Maya Guglin

The VAD Journal

In patients with chronic kidney disease (CKD) and heart failure (HF), volume overload is a major problem. Removal of fluid during the dialysis treatment, is the cornerstone management in these conditions but, assessing the amount of volume that should be removed is a challenge since physical exam findings are not accurate. Ambulatory pulmonary artery (PA) pressure measurement is a promising intervention in HF that potentially could be used as well in CKD population, predicting volume status changes and allowing a promptly intervention. We presented two cases of patient with CKD, HF and cardioMEMS

A Case Of An Acutely Ill Adult Athlete With Previously Undiagnosed Hypertrophic Obstructive Cardiomyopathy., Michael R Minckler, Madeleine Maker

Articles, Abstracts, and Reports

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic condition most commonly characterized by hypertrophy of the ventricular septum, which leads to left ventricle outflow obstruction. Due to the severity of the condition, it is often diagnosed in adolescents, especially in those who exercise. We describe the case of a 53-year-old male, previously undiagnosed with hypertrophic cardiomyopathy (HCM), who became dyspneic during a bike race. He was found to have elevated troponin, pulmonary edema, and was diagnosed with HOCM. The late presentation of the case, in an active individual, makes the situation unique.

C1q/Tnf-Related Protein 3 (Ctrp3) And 9 (Ctrp9) Concentrations Are Decreased In Patients With Heart Failure And Are Associated With Increased Morbidity And Mortality., Chao Gao, Shasha Zhao, Kun Lian, Baibing Mi, Rui Si, Zhijun Tan, Feng Fu, Shuai Wang, Rutao Wang, Xin-Liang Ma, Ling Tao

Center for Translational Medicine Faculty Papers

BACKGROUND: Biochemical marker has revolutionized the approach to the diagnosis of heart failure. However, it remains difficult to assess stability of the patient. As such, novel means of stratifying disease severity are needed. C1q/TNF-Related Protein 3 (CTRP3) and C1q/TNF-Related Protein 9 (CTRP9) are novel adipokines that contribute to energy homeostasis with additional anti-inflammatory and anti-ischemic properties. The aim of our study is to evaluate concentrations of CTRP3 and CTRP9 in patients with HFrEF (heart failure with reduced ejection fraction) and whether associated with mortality.

METHODS: Clinical data and plasma were obtained from 176 healthy controls and 168 patients with HFrEF. …