Medical Specialties Commons^™

Maintenance Therapy With A P2y12 Receptor Inhibitor After Cangrelor In Patients With Acute Coronary Syndrome The Electra-Sirio 2 Investigators’ Viewpoint, Jacek Kubica, Piotr Adamski, Robert Gajda, Aldona Kubica, Małgorzata Ostrowska, Gavino Casu, Diana A Gorog, Paul A Gurbel, Tomasz Hajdukiewicz, Miłosz Jaguszewski, Young-Hoon Jeong, Agata Kosobucka-Ozdoba, Zuzana Motovska, Piotr Niezgoda, Maciej Piasecki, Przemysław Podhajski, Paolo Raggi, Uzeyir Rahimov, Jolanta M Siller-Matula, Grzegorz Skonieczny, Łukasz Szarpak, Paweł Szymański, Udaya Tantry, Eliano P Navarese

Faculty, Staff and Students Publications

According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within …

Healthcare Utilization Unchanged In The Control Arm Of A Randomized Clinical Trial, Pratik Gongloor, Saad Nadeem, Xiaoying Yu, Mukaila Raji, Kristina D Mena, Elizabeth M Vaughan

Faculty, Staff and Students Publications

including among control groups. Increased access to care and heightened health awareness during trial enrollment could lead to altered behaviors, a phenomenon known as the Hawthorne effect, which may obscure true intervention impacts; however, this effect remains poorly studied in low-income environments.

Aim: To conduct a secondary exploratory analysis of healthcare utilization among control participants of a randomized clinical trial (RCT).

Methods: We retrospectively analyzed electronic medical records from the control arm (n = 26) of an RCT involving low-income Hispanic adults with type 2 diabetes receiving care at a community clinic. Before randomization to a 12-month diabetes education intervention …

Strategies For The Secondary Prevention Of Atherosclerotic Cardiovascular Disease, Madelyn Hurwitz, Olayinka J Agboola, Abhishek Gami, Marlene S Williams, Salim S Virani, Garima V Sharma, Jaideep Patel

Faculty, Staff and Students Publications

Patients with atherosclerotic cardiovascular disease (ASCVD), such as those with a history of MI or stroke, are at high risk for morbidity and mortality associated with future cardiovascular events. Ideal management of these patients requires a multifactorial strategy for risk factor mitigation and prevention of additional cardiovascular events. Traditional management of secondary prevention patients involves lipid-lowering with statins, blood pressure control, and anti-platelet treatment. Several additional targets have been identified to optimize the secondary prevention of ASCVD, such as further lipid control, inflammation management, lifestyle and weight optimization, strict diabetes control, use of β-blockers, use of renin-angiotensin-aldosterone system inhibitors, vaccinations, …

Causes Of Death Across Different Locations In The United States, 2015 To 2022, Taha Mansoor, Daniyal Shahid, Kartik Gupta, Dmitry Abramov, Salim S Virani, Abdul Mannan Khan Minhas

Faculty, Staff and Students Publications

Objective: The objective of this study was to investigate the leading underlying causes of death across different locations in the USA from 2015 to 2022.

Methods: Data on the leading underlying causes of death in each location of death-including medical outpatient facility or emergency room, medical inpatient facility, medical facility/dead on arrival, decedent's home, hospice facility, and nursing home/long-term care-within the USA in individuals ≥18 years were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database.

Results: There were 22,236,700 deaths in our studied locations during the study period. Most deaths …

Long-Term Health-Related Quality Of Life In Kawasaki Disease-Related Coronary Artery Aneurysm: A Large Single-Center Assessment In Nanjing, China, Yun Zhou, Mei Chen, Wenting Gao, Yu Chen, Ying Meng

The Texas Heart Institute Journal

BACKGROUND: The impact of coronary artery aneurysms (CAAs) caused by Kawasaki disease (KD) on long-term health-related quality of life (HRQOL) in children has not been well documented.

METHODS: This study investigated long-term HRQOL in a large sample of children diagnosed with KD-related CAAs. A case-control, retrospective study included 66 patients with KD-related CAAs. A total of 98 hospitalized patients were matched as controls based on age and sex: 49 patients were allocated to a group with pneumonia and 49 patients were allocated to a group with arterio-arterial fistula. Both child-reported and parent-proxy-reported Pediatric Quality of Life Inventory surveys were collected. …

Platypnea-Orthodeoxia And Patent Foramen Ovale In A Patient In The Setting Of Covid-19, Laura Sarmiento, Riyad Kherallah, Guilherme Vianna Silva

The Texas Heart Institute Journal

Platypnea-orthodeoxia syndrome is a rare condition characterized by positional dyspnea and hypoxemia, with symptoms presenting in the upright position and improving when recumbent. Hypoxemia in platypnea-orthodeoxia syndrome is defined as a drop in Pao

Double Atrial Septum With Interatrial Space In Patients Experiencing Ischemic Attack, Blerim Berisha, Fadhel Hamidani, Mathias Humm

The Texas Heart Institute Journal

No abstract provided.

Prevalence Of Hypertension Among Low-Income Individuals In Muscogee County Columbus, Georgia, Amelia K. Fallah

Theses and Dissertations

This study investigates the prevalence and predictors of elevated blood pressure (BP) among 409 low-income adults in Muscogee County, Columbus, Georgia—a population disproportionately burdened by hypertension. The findings reveal that elevated BP is significantly more prevalent among African Americans (71.4%) compared to non-African Americans (27.1%), highlighting the role of racial disparities influenced by systemic inequities, healthcare access, and chronic stress. Gender differences were modest, with females exhibiting a slightly higher prevalence (77.9%) than males (76.7%), potentially due to age-related hormonal changes post-menopause. Older adults (50+ years) represented most of the sample and showed significantly higher hypertension rates, consistent with established …

Loneliness Associates With Endothelial Dysfunction In A Community-Based Cohort: A Pilot Study And Translational Approach, Yvonne Baumer, Brian A. Tirado, Lola R. Ortiz-Whittingham, Andrew S. Baez, Cristhian A. Gutierrez-Huerta, Laurel G. Mendelsohn, Abhinav Saurabh, Joshua A. Jacobs, Marcus R. Andrews, Valerie M. Mitchell, Billy S. Collins, Antwan Jones, Danielle M. Schwartz, Anca D. Dobrian, Michael V. Stanton, Tiffany M. Powell-Wiley

Department of Biomedical and Translational Sciences Faculty Publications

Loneliness is known to be an important contributor to cardiovascular disease (CVD). However, little is known about the impact of loneliness on endothelial barrier integrity, a crucial hallmark of CVD development and progression. In this study, we aimed to investigate how loneliness might impact the endothelium. We found greater perceived loneliness associated with the product of circulating epinephrine and TNFα (E/T), which, in turn, associated with lower VE-cadherin on endothelial cells in an ex vivo experiment. Additionally, circulating plasma levels of soluble VE-cadherin were associated significantly with subclinical CVD. To explore the mechanistic aspects of these associations, we measured the …

Interaction Of Cardiac Leiomodin With The Native Cardiac Thin Filament, Madison Little, Cristina M. Risi, Tania M. Larrinaga, Mason D. Summers, Tyler Nguyen, Garry E. Smith Jr., Jennifer Atherton, Carol C. Gregorio, Alla S. Kostyukova, Vitold E. Galkin

Department of Biomedical and Translational Sciences Faculty Publications

Every heartbeat depends on cyclical contraction-relaxation produced by the interactions between myosin-containing thick and actin-based thin filaments (TFs) arranged into a crystalline-like lattice in the cardiac sarcomere. Therefore, the maintenance of thin filament length is crucial for myocardium function. The thin filament is comprised of an actin backbone, the regulatory troponin complex and tropomyosin that controls interactions between thick and thin filaments. Thin filament length is controlled by the tropomodulin family of proteins; tropomodulin caps pointed ends of thin filaments, and leiomodin (Lmod) promotes elongation of thin filaments by a “leaky-cap” mechanism. The broader distribution of Lmod on the thin …

Deletion Of Chop In Beta Cell Protects Mice From Cardiovascular Complications In Type 2 Diabetes: Evidence From A Pre-Clinical Mouse Model, Balaji Srinivas, Kiran Alluri, Nour-Eddine Rhaleb, Khalid Matrougui

Department of Biomedical and Translational Sciences Faculty Publications

Introduction

Cardiovascular complications are the leading cause of morbidity and mortality in patients with type 2 diabetes (T2D), which is recognized as a major independent risk factor for coronary artery disease, stroke, peripheral vascular disease, and heart failure. The interrelationship between metabolic dysfunction and cardiovascular disease is complex and multifactorial, involving hyperglycemia, insulin resistance, inflammation, and oxidative stress. Evidence indicates that endoplasmic reticulum (ER) stress and induction of the unfolded protein response (UPR) contribute to metabolic dysregulation and vascular dysfunction. However, the specific role of beta cell-derived UPR mediators, particularly C/EBP homologous protein (CHOP), in coordinating this interorgan axis between …

From Trials To Practice: Implementing A Clinical Intervention In Community Settings, Elizabeth M Vaughan, Xiaoying Yu, Victor J Cardenas, Craig A Johnston, Salim S Virani, Ashok Balasubramanyam, Christie M Ballantyne, Aanand D Naik

Faculty, Staff and Students Publications

Introduction/objectives: Diabetes increases the risk of complications, especially for vulnerable populations. Our previous randomized clinical trial (RCT), TIME (Telehealth-supported, Integrated Community Health Workers (CHWs), Medication access, group visit Education), showed the efficacy of CHW-led diabetes care. This study aimed to gather data on transitioning TIME from clinical trials to practical implementation.

Methods: We conducted a 12-month RCT at a nonprofit community clinic using the Consolidated Framework for Implementation Research (CFIR). Participants, Hispanic adults without insurance and with type 2 diabetes (N = 58; 29/arm), were randomized to TIME (intervention) or usual care (control). The intervention included monthly group visits and …

Hydroxychloroquine-Induced Cardiomyopathy: A Case Report, Ahmed Hussein, Aya Salih, Tebyan Mohammedali, Yousif Mohamed, L Maximilian Buja

Faculty, Staff and Student Publications

Hydroxychloroquine (HCQ) is an immunomodulatory medication used for decades. HCQ is a weak base accumulating in acidic cytoplasmic vesicles, such as lysosomes. This accumulation raises the pH and interferes with the functions of the lysosomal enzymes, including α-galactosidase A, resulting in a unique clinical and pathologic feature. We present a case with severe HCQ-induced cardiomyopathy to show the pattern of cardiac involvement and available imaging and pathologic modalities. The case involves a 76-year-old woman with a history of Sjögren's disease who had been treated with HCQ for 13 years and presented with symptoms of heart failure. An echocardiogram showed thick …

Contributions Of Pathobiological And Translational Science To Understanding And Managing Ischemic Heart Disease: Progress, Impediments, And Future Directions, L Maximilian Buja

The Texas Heart Institute Journal

Key pathobiological components of ischemic heart disease have been identified as follows: (1) In 1970 to 1973, myocardial infarct size was found to be the primary determinant of prognosis after acute myocardial infarction (AMI); (2) in 1973 to 1989, vulnerable coronary artery plaques were found to predispose individuals to coronary plaque disruption and thrombosis, causing major AMI; (3) in 1972, timely coronary reperfusion was demonstrated to limit the size of evolving AMI but with risk of reperfusion injury; and (4) in 1986, myocardial conditioning was found to be a clinically significant modulator capable of delaying AMI progression. Promising cardioprotective strategies …

The Mental Health Of Cardiology Fellows In Training, Juan Simon Rico-Mesa, Suman M Atluri, Maria Antonia Rico-Mesa

The Texas Heart Institute Journal

No abstract provided.

Effective Thrombectomy For Biventricular Thrombosis With An Endoscope Via The Aortic And Tricuspid Heart Valves, Yuki Endo, Yoshiei Shimamura, Chizuo Kikuchi, Hiroshi Niinami

The Texas Heart Institute Journal

The simultaneous formation of thrombi in the left and right ventricles is extremely rare, and this condition's clinical characteristics and prognosis remain unknown. Therefore, treatment methods are still controversial. This case highlights the potential for endoscopic thrombectomy as a viable option for the treatment of giant floating biventricular thrombi in a patient with restricted cardiac function. This approach via the aortic and tricuspid heart valves allowed for effective and complete removal of the thrombi, thereby preventing further embolic complications.

Lyme Carditis And Inflammation-Driven Plaque Erosion Presenting As Sudden Cardiac Arrest, Marco Kaldas, Moneal Shah, Diana Pashaieva, Georgios Lygouris, Anita Radhakrishnan

The Texas Heart Institute Journal

Lyme carditis represents a rare cardiac complication of Borrelia burgdorferi infection, often causing conduction disturbances but rarely causing malignant arrhythmias. Inflammatory acute coronary syndrome, driven by immune-mediated plaque erosion rather than rupture, represents a nontraditional ischemic mechanism. This case highlights their overlap. The case of a previously healthy man with Lyme disease who experienced cardiac arrest because of ventricular tachycardia is reported. Imaging showed myocardial inflammation together with coronary plaque erosion instead of plaque rupture. The patient underwent advanced diagnostic testing and received multidisciplinary medical care, which led to complete cardiac recovery and implantable cardioverter-defibrillator placement.

Early Structural Valve Deterioration And Cusp Tear Leading To Acute Heart Failure In A Second-Generation Trifecta Glide Technology Heart Valve, Akiyoshi Yamamoto, Kenji Kuwaki, Hidekazu Furuya, Yasunori Cho

The Texas Heart Institute Journal

This report highlights a case of early structural valve deterioration with a cusp tear in a second-generation Abbott Trifecta Glide Technology bioprosthetic heart valve. A 70-year-old man had undergone aortic valve replacement with a Trifecta Glide Technology valve 30 months earlier for severe bicuspid aortic valve stenosis. He suddenly developed acute heart failure with dyspnea resulting from severe aortic valve regurgitation, with a cusp tear in the Trifecta Glide Technology valve, as demonstrated by transthoracic echocardiography. The patient was successfully treated with urgent repeat aortic valve replacement.

Midterm Outcomes Of Pediatric Mitral Valvuloplasty For Moderate To Severe Mitral Valve Regurgitation And Associated Risk Factors For Postoperative Deterioration, Hongyuan Fu, Aijun Liu, Ming Yang, Zeyu Liu, Junwu Su

The Texas Heart Institute Journal

BACKGROUND: Mitral valvuloplasty is considered the best treatment for pediatric mitral valve regurgitation. The objective of this analysis was to identify risk factors for postoperative mitral valve regurgitation progression and evaluate valvuloplasty effectiveness.

METHODS: This retrospective, single-center study investigated the clinical efficacy of mitral valvuloplasty and identified factors that affect prognosis. Pediatric patients with moderate or severe mitral valve regurgitation who had undergone mitral valvuloplasty between September 2016 and August 2023 were included. Kaplan-Meier survival analysis was used to assess freedom from both mitral valve deterioration and cardiovascular death. Univariate and multivariate Cox regression analyses were performed to identify potential …

Accidental Left Ventricular Placement Of A Leadless Micra Pacemaker Through A Patent Foramen Ovale, Hamza Alkowatli, Mahmoud Kutmah, Adnan Shaik, Osama Hallak

The Texas Heart Institute Journal

The Micra device is a leadless pacemaker implanted in the right ventricle via a femoral vein transcatheter approach. There are several indications for and advantages to using a leadless pacemaker, and the device's role in the field of cardiology will probably continue to increase. This article presents the case of a rare complication probably due to inadvertent placement of the device in the left ventricle across an undiagnosed patent foramen ovale.

Shaping The Future Of "Cardio-Kidney-Metabolic" Health: Insights From The Texas Heart Institute's 2024 Cardiometabolic Syndrome Conference, Arjun Raghuram, Keri Sprung, Stephanie Coulter, Joseph G Rogers

The Texas Heart Institute Journal

At the Texas Heart Institute's 2024 Cardiometabolic Syndrome Conference, held on August 23, 2024, experts from diverse academic fields spoke about novel initiatives for addressing the worsening projections for cardiometabolic syndrome. Four major areas in which innovation is ongoing were highlighted: technology, policy, population health, and lifestyle and behavioral modification. This article presents a brief contextualization, summary, and analysis of the novel initiatives being implemented in each of these 4 areas to address cardiometabolic syndrome. Despite alarming projections, cardiometabolic syndrome presents a unique opportunity for innovators to drive change through collaborative, multidisciplinary efforts.

Sequelae And Surgical Management Of Giant Cardiac Myxoma, Norvin Hernandez, Michael Dileo, Christopher K Wong, Mahboob Alam

The Texas Heart Institute Journal

Cardiac myxomas are a rare phenomenon within the general population, and although there are reports of them, giant myxomas are not common in the medical literature. This report presents a case of a giant left atrial cardiac myxoma in a 57-year-old female patient who was largely asymptomatic until she presented with a diffuse thromboembolic stroke. This case report highlights the importance of surgical management of cardiac myxomas and discusses the difference in open vs minimally invasive surgical resection of giant cardiac myxomas.

Robot-Assisted Surgical Treatment Of Caseoma, Nancy Wang, Abdussalam Elsenousi, Kenneth K Liao

The Texas Heart Institute Journal

This report reviews 5 cases of mitral annular caseoma. Four patients presented with fatigue, stroke, or mitral stenosis. Robot-assisted resection of caseoma with or without mitral valve replacement was successfully performed in all patients with good outcomes. These cases demonstrate the safety and efficacy of robotic surgery in treating caseoma.

Navigating The Complexities Of Mitral Valve Clipping: Early Severe Mitral Valve Stenosis After Mitral Valve Clipping, Wassim Abouzeid, Ahmad Haddad, Chrystina Kiwan, Ahsan Khan, Addi Suleiman

The Texas Heart Institute Journal

This case study explores the journey of an 80-year-old male patient with a history of hypertension, diabetes, coronary artery disease after coronary artery bypass grafting, atrial fibrillation, and heart failure. Nine months before he presented to the emergency department, he had undergone mitral valve clipping for severe mitral valve regurgitation. Despite initial improvement, the patient experienced return of symptoms, including dyspnea at rest and lower limb edema. The results of this case-discovery of the need for mitral valve replacement-provides insights into the management of complications from mitral valve clipping and emphasizes that management requires a nuanced, meticulous approach.

Micra Leadless Pacemaker Implantation Via Transjugular Approach, Yuen-Fung Yiu, Ngai-Yin Chan

Journal of the Hong Kong College of Cardiology

Leadless pacemaker implantation offers a safe and effective option for patients with limited venous access or high bleeding risk. The procedure usually necessitates insertion of a large-bore sheath over the femoral vein. We report a case of successful Micra^TM implantation via transjugular approach in a patient with inferior vena cava obstruction.

Atrial Fibrillation Burden And Clinical Outcomes In Dual-Chamber Pacemaker Recipients, Ka Ho Oscar Chiu, Shou Yan Kam, Ka Chun Kevin Lee, To Shing Wong, Jacky Kit Chan, Yuk-Kong Lau, Kwok-Lun Lee, Wai-Ling Jessica Poon

Journal of the Hong Kong College of Cardiology

Background

Pacemaker-detected atrial fibrillation (PDAF) and its burden are associated with adverse clinical outcomes, but consensus is lacking on its definition and local clinical outcomes are unclear. We evaluated PDAF, its burden and relationship with major adverse cardiovascular and cerebrovascular events (MACCE).

Methods

This retrospective study recruited adult patients receiving dual-chamber pacemakers from 2014 to 2022. The presence of PDAF of 5 minutes, PDAF burden (defined by the longest episode) and time to new-onset PDAF were measured and analysed. High PDAF burden was defined as PDAF lasting 24 hours.

Results

A total of 275 patients were analysed and followed for …

Will Conduction System Pacing Replace Biventricular Pacing For Treating Heart Failure In Patients With Wide Qrs Duration?, Chan Yat Sun Joseph

Journal of the Hong Kong College of Cardiology

Conduction system pacing CSP) is an emerging therapy for resynchronization of patients with heart failure and wide QRS duration. It has been proposed to replace cardiac resynchronization therapy with biventricular pacing (CRT with BVP) mainly because of shortcoming of CRT with BVP including failure to implant coronary sinus leads and unsatisfactory response in certain subset of heart failure patients. The current evidence for CSP in heart failure patients with wide QRS duration is reviewed and the gap in evidence in supporting CSP to replace CRT with BVP is discussed.

Challenges Faced In Managing The Hemodynamic Status Due To Recurrent Gastrointestinal Bleeding In Typhoid Fever With Uncorrected Double Outlet Right Ventricle Patient: A Case Report, Kellyn Trycia Zenjaya, Lindawati Wijoyo, Jovan Amadeo Muliyanto, Rizqi Rokhmadhoni Pikir, Dwi Putri Lestari, Esthy Poespitaningtyas

Journal of the Hong Kong College of Cardiology

Double Outlet Right Ventricle (DORV) is a rare cyanotic congenital heart defect often associated with polycythemia and bleeding risk. A 7-year-old boy with uncorrected DORV presented with fever, melena, and shock. He was cyanotic, tachypneic, and tachycardic, with SpO₂ of 68% and a harsh ejection systolic murmur. Labs showed anemia, thrombocytopenia, leukocytosis, and prolonged APTT. Tubex TF IgM was strongly positive. A diagnosis of typhoid fever with gastrointestinal bleeding and uncorrected DORV was made. Management included oxygen, inotropes, and fluid resuscitation. Propranolol was withheld. Severe infection with underlying cyanotic heart disease and coagulopathy presents a critical management dilemma.

Characteristics And Clinical Outcomes Of Young Patients With St-Segment Elevation Myocardial Infarction A Retrospective Study, Cheung Pak Nung Rocco, Chi Yan Raymond Fung

Journal of the Hong Kong College of Cardiology

Background ST-segment elevation myocardial infarction (STEMI) carries high mortality and poor outcomes without timely treatment. Its occurrence in young patients is especially concerning due to social impact. Objectives This study examined the characteristics and outcomes of young STEMI patients in Hong Kong to identify areas for public health improvement. Methods We retrospectively reviewed STEMI patients admitted to Princess Margaret Hospital from January 2019 to January 2023 who underwent coronary angiography and reperfusion therapy. Patients were grouped as young (years) or older (≥50 years). Results Out of 818 patients treated with PCI, 102 (12.5%) were under 50 years old. Compared to …

Bridging Awareness, Risk, And Innovation In Peripheral Arterial Disease, Guang-Ming Tan, Bryan P. Yan

Journal of the Hong Kong College of Cardiology

No abstract for this article type.