Medical Specialties Commons^™

Effectiveness Of An Educational And Interdisciplinary Intervention In Reducing Continuous Cardiac Monitoring In An Academic Medical Center, Alexander Smith, Md, Rebecca Loh, Md, Philip Margiotta, Md, Bradford Hilson, Md, Alan Kubey, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Smart Aim Statement

• Our study aimed to assess the effect of a combined resident-education-and rounding-checklist-protocol intervention on the percentage of patients discharged with active CCM orders on teaching general medicine services.
• We hypothesized that our intervention would reduce the number of patients discharged on CCM (an estimate of overall inappropriate CCM use) by 50% over a 6-8 week period

Early Rapid Decline In Kidney Function In Medically Managed Patients With Atherosclerotic Renal Artery Stenosis., Emily L Cooper, Yanmei Xie, Hanh Nguyen, Pamela S Brewster, Haden Sholl, Megan Sharrett, Kaili Ren, Tian Chen, Katherine Tuttle, Steven T Haller, Kenneth Jamerson, Timothy P Murphy, Ralph B D'Agostino, Joseph M Massaro, William Henrich, Christopher J Cooper, Donald E Cutlip, Lance D Dworkin, Joseph I Shapiro

Articles, Abstracts, and Reports

Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy-only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy-only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of …

Pc202. Evolution Of Vascular Complications In Transfemoral Transcatheter Aortic Valve Replacement, Brant W Ullery, Ruyun Jin, Eric B Kirker, Patrick Ryan, Leland Siwek, James Brevig, Robert W. Hodson, Kateri Spinelli

Articles, Abstracts, and Reports

Objective Vascular complications (VCs) after transfemoral transcatheter aortic valve replacement (TAVR) have historically been common and associated with significant morbidity and mortality. We evaluated our large multicenter experience to provide new insight on the incidence, predictors, management, and clinical impact of VCs after TAVR.

Methods Retrospective TVT registry and chart review was performed for 1573 patients undergoing commercial transfemoral TAVR across seven centers within our hospital network between 2012 and 2016. VCs and bleeding complications (BCs) were defined by Valve Academic Research Consortium-2 definitions. Incidence of 30-day VCs and BCs, treatment strategy, and outcomes were reported. A mixed-effects model with …

Hdl Subclass Proteomic Analysis And Functional Implication Of Protein Dynamic Change During Hdl Maturation, Yuling Zhang, Scott M. Gordon, Hang Xi, Seungbum Choi, Merlin Abner Paz, Runlu Sun, William Yang, Jason Saredy, Mohsin Khan, Alan Thomas Remaley, Jing-Feng Wang, Xiaofeng Yang, Hong Wang

Saha Cardiovascular Research Center Faculty Publications

Recent clinical trials reported that increasing high-density lipoprotein-cholesterol (HDL-C) levels does not improve cardiovascular outcomes. We hypothesize that HDL proteome dynamics determine HDL cardioprotective functions. In this study, we characterized proteome profiles in HDL subclasses and established their functional connection. Mouse plasma was fractionized by fast protein liquid chromatography, examined for protein, cholesterial, phospholipid and trigliceride content. Small, medium and large (S/M/L)-HDL subclasseses were collected for proteomic analysis by mass spectrometry. Fifty-one HDL proteins (39 in S-HDL, 27 in M-HDL and 29 in L-HDL) were identified and grouped into 4 functional categories (lipid metabolism, immune response, coagulation, and others). Eleven …

Cardiothoracic Surgery Residency Training In Surgical Ablation For Atrial Fibrillation., Zachary M Deboard, Thomas K Varghese, John R Doty, Craig H Selzman

Articles, Abstracts, and Reports

Background: As no standardized curriculum exists for training cardiothoracic surgery residents in surgical ablation for atrial fibrillation there is potential for variation in operative technique, patient selection, and overall application. Thus we sought to assess the exposure of current residents in order to identify areas for improvement in their education.

Methods: A survey was emailed to residents inquiring about their training experience in surgical ablation for atrial fibrillation. Residents were asked about case volume, procedural variety, and guideline-based clinical scenarios where they felt ablation would be appropriate. Residents were also queried about their abilities to perform various lesion sets and …

Outcomes Of Left Main Percutaneous Coronary Intervention, Nasir Rahman, Bilal Hussain, Azmina Artani

Section of Cardiology

Objective: To study the outcomes of left main percutaneous coronary artery (LMCA) revascularisation.

Study Design: A descriptive study.

Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from February till July 2016.

Methodology: The study included all adult patients aged 18 years or more, who underwent percutaneous LMCA revascularisation at study centre from April 2006 till April 2015. In-hospital outcomes were ascertained of patients via charts along with telephonic follow-up for outcome ascertainment at 1-year and 5-year. Results were expressed in terms of means and standard deviation for quantitative variables and percentages for qualitative variables.

Results: Of …

Aminophylline Shortage And Current Recommendations For Reversal Of Vasodilator Stress: An Asnc Information Statement Endorsed By Scmr, Aiden Abidov, Vasken Dilsizian, Rami Doukky, W Lane Duvall, Christopher Dyke, Michael D Elliott, Fadi G Hage, Milena J Henzlova, Nils P Johnson, Ronald G Schwartz, Gregory S Thomas, Andrew J Einstein

Faculty, Staff and Student Publications

Pharmacologic reversal of serious or intolerable side effects (SISEs) from vasodilator stress is an important safety and comfort measure for patients experiencing such effects. While typically performed using intravenous aminophylline, recurrent shortages of this agent have led to a greater need to limit its use and consider alternative agents. This information statement provides background and recommendations addressing indications for vasodilator reversal, timing of a reversal agent, incidence of observed SISE with vasodilator stress, clinical and logistical considerations for aminophylline-based reversal, and alternative non-aminophylline based reversal protocols.

Incidence And Predictors Of Obstructive Coronary Artery Disease And The Role Of Cardiac Troponin Assays In Patients With Unstable Angina, Sushan Yang, Nirmanmoh Bhatia, Meng Xu, John A Mcpherson

The Texas Heart Institute Journal

In a time when cardiac troponin assays are widely used to detect myocardial injury, data remain scarce concerning the incidence and predictors of substantial obstructive coronary artery disease that causes unstable angina. This retrospective single-center study included consecutive patients hospitalized for unstable angina from January 2015 through January 2016. Patients with troponin I levels above the upper reference limit and those who did not undergo angiography were excluded. Multivariate logistic regression analysis was used to identify predictors of obstructive coronary artery disease that warranted revascularization and of major adverse cardiac events up to 6 months after discharge from the hospital. …

Goosebumps, Efrain Rodriguez

The Texas Heart Institute Journal

No abstract provided.

Adam Christian Thebesius' Channels Into The Human Heart: The Thebesian Veins And The Thebesian Valve, Magdalena Mazurak, Jacek Kusa

The Texas Heart Institute Journal

In 1708, Adam Christian Thebesius, a 22-year-old student at Leiden University, presented his graduate thesis, Disputatio medica inauguralis de circulo sanguinis in corde. More than a doctoral dissertation, this groundbreaking work opened new channels into the study of the human coronary venous system. Thebesius' theory about the vascular communication between the coronary arteries and the chambers of the heart helped to advance understanding of hemodynamic principles and to clarify the physiologic pathways of the coronary circulation. The following article—the third in a trilogy about Lower Silesian scientists—provides an overview of the life story and achievements of this Silesian physician …

Osborn Waves: Differential Diagnosis, Akriti G Jain, Hammad Zafar, Sanjay Jain, Jason D'Souza

The Texas Heart Institute Journal

No abstract provided.

Percutaneous Coronary Intervention For Interposed Coronary Graft Stenosis After Modified Bentall Procedure In A Teenaged Boy With Takayasu Arteritis, Hiroki Ikenaga, Satoshi Kurisu, Yasuki Kihara

The Texas Heart Institute Journal

Anastomotic occlusion of an interposed coronary artery graft after a Bentall procedure is rare and catastrophic. It can lead to myocardial infarction or sudden cardiac death. We found several reports of occlusion and stenosis of a coronary-graft anastomosis, but few describe occlusion of the interposed coronary graft itself, as evaluated with use of intracoronary ultrasonography and computed tomography. We report the case of a 17-year-old boy with Takayasu arteritis who had a myocardial infarction caused by severe ostial stenosis in an interposed left coronary graft. The graft occlusion was confirmed by results of electrocardiography, aortography, and intracoronary ultrasonography. The patient …

Endoanchors Minimize Endoleaks In Chimney-Graft Endovascular Repair Of Juxtarenal Abdominal Aortic Aneurysms, Edgar Luis Galiñanes, Eduardo A Hernandez-Vila, Zvonimir Krajcer

The Texas Heart Institute Journal

Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through …

Anomalous Origin Of The Right Coronary Artery From The Pulmonary Artery In A Neonate With Turner Syndrome And Aortic Arch Hypoplasia, Bryan P Stefek, Jason R Imundo, Joseph B Clark

The Texas Heart Institute Journal

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. …

The Man With 2 Hearts: 25 Years From Heterotopic To Orthotopic Heart Transplantation, Elizabeth L Godfrey, Michael L Kueht, Abbas Rana, O H Frazier

The Texas Heart Institute Journal

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft …

Surgical Thrombectomy For Pulmonary Embolism: Updated Performance Rates And Outcomes, Fahad Alqahtani, Muhammad Bilal Munir, Sami Aljohani, Abdul Tarabishy, Ahmad Almustafa, Mohamad Alkhouli

The Texas Heart Institute Journal

Treatments for pulmonary embolism are numerous and often complex. Current data on surgical thrombectomy are important but are not readily available. We studied the National Inpatient Sample to evaluate trends in the performance rates and outcomes of surgical thrombectomy in the United States from 2003 through 2014. We think that our findings have meaningful application to the triage and risk stratification of patients who have hemodynamically significant pulmonary embolism.

Atrial Fibrillation And Exercise: Exercise Recommendations, Paul Sorace, Peter Ronai, Robert Berry

Exercise Science Faculty Publications

Atrial fibrillation (AF), characterized by a rapid pulse rate and an irregular heart rhythm. It is a more common cardiac arrhythmia. AF may lack symptoms, although fatigue and an impaired exercise ability are common symptoms. This column will discuss exercise testing and training recommendations as well as special considerations.

Mortality Not Correlated With Paclitaxel Exposure: An Independent Patient-Level Meta-Analysis Of A Drug-Coated Balloon., Peter A Schneider, John R Laird, Gheorghe Doros, Qi Gao, Gary Ansel, Marianne Brodmann, Antonio Micari, Mehdi H Shishehbor, Gunnar Tepe, Thomas Zeller

Heart and Vascular Articles

BACKGROUND: Five years of prospective clinical trials confirm that the paclitaxel drug-coated balloon (DCB) (IN.PACT Admiral, Medtronic, Dublin, Ireland) is safe and effective to treat femoropopliteal artery disease. A recent meta-analysis of heterogeneous trials of paclitaxel-based balloons and stents reported that they are associated with increased mortality and that higher doses are linked to higher mortality from 2 to 5 years.

OBJECTIVES: The purpose of this study was to determine if there is a correlation between paclitaxel exposure and mortality by conducting an independent patient-level meta-analysis of 1,980 patients with up to 5-year follow-up.

METHODS: Data from 2 single-arm and …

Scintillation Event Localization In Novel Hemi-Ellipsoid Detector For Spect, Hanif R. Soysal

LSU Master's Theses

A high sensitivity Cardiac SPECT system using hemi-ellipsoid crystals with pinhole collimation was previously proposed by Dey et al. To investigate detector resolution for this design, the scintillation light spread on a monolithic hemi-ellipsoidal CsI crystal was simulated using Geant4 Monte Carlo. The expected distribution of scintillation light on the outer surface of the crystal from photoelectric absorption events was obtained from the simulations for selected points inside the crystal. Two sets of simulations were performed. For the first set, a look-up table (LUT) of 12 points was created and each point mapped to its expected light distribution—four points at …

The Clinical Rationale For The Sentry Bioconvertible Inferior Vena Cava Filter For The Prevention Of Pulmonary Embolism., Michael D Dake, Gary M Ansel, Matthew S Johnson, Robert Mendes, H Bob Smouse

Heart and Vascular Articles

The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection against pulmonary embolism (PE) during transient high-risk periods and then to bioconvert after 60 days after implantation. At the time of bioconversion, the device's nitinol arms retract from the filtering position into the caval wall. Subsequently, the stable stent-like nitinol frame is endothelialized. The Sentry bioconvertible IVC filter has been evaluated in a multicenter investigational-device-exemption pivotal trial (NCT01975090) of 129 patients with documented deep vein thrombosis (DVT) or PE, or at temporary risk of developing DVT or PE, and with contraindications to anticoagulation. Successful filter conversion was …

View Point On Social Media Use In Interventional Cardiology, Mirvat Alasnag, Mamas Mamas, David Fischman, Salvatore Brugaletta, Jordan Safirstein, Pascal Meier, Vijay Kunadian, Lukasz Koltowski, Sheila Sahni, Chadi Alraies, Michael Gibson

Division of Cardiology Faculty Papers

No abstract provided.

Radiation Induced Symptomatic Critical Left Main Lesion And Symptomatic Aortic Stenosis In An Inoperable Candidate: Role Of Percutaneous Intervention, Fnu Vikram Md, Ghulam Akbar Md, Mohammed Ameen Md, Roshni N. Patel, Lohit Garg Md, Deborah W. Sundlof Do, Nainesh C. Patel Md

Department of Medicine

No abstract provided.

Association Of Ambulatory Hemodynamic Monitoring With Clinical Outcomes In A Concurrent Matched Control Analysis., Jacob Abraham, Rupinder Bharmi, Orvar Jonsson, Guilherme H Oliveira, Andre Artis, Ali Valika, Robert Capodilupo, Philip B Adamson, Gregory Roberts, Nirav Dalal, Akshay S Desai, Raymond L Benza

Articles, Abstracts, and Reports

Importance: In a randomized clinical trial, heart failure (HF) hospitalizations were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care. It remains unclear if ambulatory monitoring could also improve long-term clinical outcomes in real-world practice.

Objective: To determine the association between ambulatory hemodynamic monitoring and rates of HF hospitalization at 12 months in clinical practice.

Design, Setting, and Participants: This case-control study of Medicare beneficiaries used claims data collected between June 1, 2014, and March 31, 2016. Medicare patients who received implants of a pulmonary artery pressure sensor were identified from the …

Permanent Junctional Reciprocating Tachycardia In Infants And Children, Ranjit I. Kylat Md, Ricardo A. Samson

School of Medicine Faculty Research

Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT. Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate …

Effect Of Intravenous Phenobarbital On Left Ventricular Myocardial Contractility Determined By Echocardiography In Children., Arpan R. Doshi, Monesha Gupta Malhotra, Duraisamy Balaguru, Devendra Amre, Christian Erikson

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Animal studies and rare human studies have suggested a negative effect of barbiturates on cardiac function. Although intravenous (IV) phenobarbital is used routinely in children in the clinical setting, studies in children are lacking. We performed a study to evaluate effect of IV phenobarbital loading on myocardial systolic function of children.

Methods: In a prospective pilot study in children without congenital heart defects, the effect of IV phenobarbital was evaluated on the left ventricular systolic function measured by ejection fraction (EF) by Simpson's method via an echocardiogram. Any child less than 18 years of age who received IV loading …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

Antibody-Based Ticagrelor Reversal Agent In Healthy Volunteers., Deepak L. Bhatt, Charles V. Pollack, Jeffrey I. Weitz, Lisa K. Jennings, Sherry Xu, Susan E. Arnold, Bret R. Umstead, Michael C. Mays, John S. Lee

Department of Emergency Medicine Faculty Papers

BACKGROUND: Ticagrelor is an oral P2Y₁₂ inhibitor that is used with aspirin to reduce the risk of ischemic events among patients with acute coronary syndromes or previous myocardial infarction. Spontaneous major bleeding and bleeding associated with urgent invasive procedures are concerns with ticagrelor, as with other antiplatelet drugs. The antiplatelet effects of ticagrelor cannot be reversed with platelet transfusion. A rapid-acting reversal agent would be useful.

METHODS: In this randomized, double-blind, placebo-controlled, phase 1 trial, we evaluated intravenous PB2452, a monoclonal antibody fragment that binds ticagrelor with high affinity, as a ticagrelor reversal agent. We assessed platelet function in …

Trends And Predictors Of Implantable Cardioverted Defibrillator In Patients With Cardiac Arrest, Lohit Garg Md, Syed Rafay Ali Sabzwari Md, Aakash Garg Md, Manyoo Agarwal Md, Sahil Agrawal Md, Sima Y. Hodavance Md, Raman Dusaj Md, Nainesh C. Patel Md, Jeffrey Gordon Md

Department of Medicine

No abstract provided.

The Relationship Between Psychological States And Health Perception In Individuals At Risk For Cardiovascular Disease, Kyoung Suk Lee, Frances J. Feltner, Alison L. Bailey, Terry A. Lennie, Misook L. Chung, Brittany L. Smalls, Donna L. Schuman, Debra K. Moser

Family and Community Medicine Faculty Publications

Backgrounds: Perceptions of health are important to motivate people to change behaviors. Non-adherence to healthy behaviors that prevent cardiovascular disease may result from inadequate health perceptions. However, there are few studies investigating relationships between health perceptions and psychological states.

Objective: To determine whether psychological states (ie, depressive symptoms and anxiety) are associated with the congruency between health perception and estimated risk for cardiovascular disease in adults with 2 or more cardiovascular disease risk factors.

Methods: Community dwellers at risk for cardiovascular disease were asked to complete the Patient Health Questionnaire-9 and the anxiety subscale of the Brief Symptom Inventory to …

One Amino Acid Change Of Angiotensin Ii Diminishes Its Effects On Abdominal Aortic Aneurysm, Ya Wang, Yinchuan Xu, Congqing Wu, Hongguang Xia, Yingchao Wang, Jinliang Nan, Jinghai Chen, Hong Yu, Wei Zhu, Peng Shi, Alan Daugherty, Hong S. Lu, Jian'an Wang

Saha Cardiovascular Research Center Faculty Publications

Angiotensin (Ang) A is formed by the decarboxylation of the N terminal residue of AngII. The present study determined whether this one amino acid change impacted effects of AngII on abdominal aortic aneurysm (AAA) formation in mice. Computational analyses implicated that AngA had comparable binding affinity to both AngII type 1 and 2 receptors as AngII. To compare effects of these two octapeptides in vivo, male low-density lipoprotein receptor (Ldlr) or apolipoprotein E (Apoe) deficient mice were infused with either AngII or AngA (1 μg/kg/min) for 4 weeks. While AngII infusion induced AAA consistently in …