Medical Specialties Commons^™

Feasibility Of A Sensor-Controlled Digital Game For Heart Failure Self-Management: Randomized Controlled Trial, Kavita Radhakrishnan, Christine Julien, Tom Baranowski, Matthew O'Hair, Grace Lee, Atami Sagna De Main, Catherine Allen, Bindu Viswanathan, Edison Thomaz, Miyong Kim

Faculty, Staff and Students Publications

BACKGROUND: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF.

OBJECTIVE: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial.

METHODS: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to …

Left Atrial Appendage Occlusion For Stroke Prevention In Nonvalvular Atrial Fibrillation, Fareed Moses S Collado, Claudia M Lama Von Buchwald, Christina K Anderson, Nidhi Madan, Hussam S Suradi, Henry D Huang, Hani Jneid, Clifford J Kavinsky

Faculty, Staff and Students Publications

The majority of embolic strokes in patients with nonvalvular atrial fibrillation are caused by thrombi in the left atrial appendage. It is projected that strokes related to atrial fibrillation will markedly increase in the future unless effective mitigation strategies are implemented. Systemic anticoagulation has been known to be highly effective in reducing stroke risk in patients with atrial fibrillation. However, bleeding complications and nonadherence are barriers to effective anticoagulation therapy. Surgical and percutaneous left atrial appendage occlusion devices are nonpharmacologic strategies to mitigate the challenges of drug therapy. We present a contemporary review of left atrial appendage occlusion for stroke …

Features On Cardiac Magnetic Resonance Imaging And Accuracy Of Echocardiographic Findings For Diagnosing Constrictive Pericarditis, Salik Ur Rehman Iqbal, Fateh Ali Tipoo Sultan

Section of Cardiology

Constrictive pericarditis is a rare disease with a difficult diagnosis. Cardiac magnetic resonance (CMR) imaging data of Aga Khan University Hospital from January 2011 to March 2020 was retrospectively reviewed and patients with the diagnosis of constrictive pericarditis were included. A total of 22 patients were included with the mean age of 46±16 years and majority 17(77%) were male. The most common findings on transthoracic echo were significant respiratory variation in mitral and tricuspid inflow velocities in 20(91%), and septal annular e'>9 in 10 (86%). The most common finding on CMR was respiratory septal shift in 22(100%), followed by …

Clinical Outcomes Of Physiologically-Guided Revascularisation, Nasir Rahman, Ghufran Adnan, Awais Farhad, Jamshed Ali, Ihsan Ullah

Section of Cardiology

Objective: To assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR).
Study design: Descriptive study.
Place and duration of study: Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020.
Methodology: A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and …

Covid-19 Bbibp-Corv Vaccine And Transient Heart Block - A Phenomenon By Chance Or A Possible Correlation - A Case Report, Pirbhat Shams, Jamshed Ali, Sheema Saadia, Aamir Hameed Khan, Fateh Ali Tipoo Sultan, Javed Tai

Section of Cardiology

Importance: Bradyarrhythmia during COVID19 illness carries prognostic significance. Electrophysiological side effects of COVID19 vaccine remain largely unknown. It is imperative to report nature of cardiovascular side effects of the vaccine.
Case presentation: An 80 years-old-man presented with complains of dizziness, trepidation and shortness of breath following his first shot of COVID-19 BBIBP-CorV (Sino-pharm). ECG on arrival showed 2:1 atrioventricular block with an underlying old left bundle branch block. The AV block changed into Mobitz type-I over the course of next 2 days and into a sinus 1:1 conduction on fourth day of presentation. However, our patient underwent permanent pacemaker implantation …

Surgical Treatment Of Valvular Heart Disease In Nigeria: A 6-Year Experience, Ikechukwu A Nwafor, John C Eze, Maureen N Nwafor

The Texas Heart Institute Journal

Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11–80 yr]) underwent surgical treatment of a total …

Patient Characteristics And Outcomes Of Type 2 Myocardial Infarction During Heart Failure Hospitalizations In The United States, Salik Nazir, Abdul Mannan Khan Minhas, Ishan S Kamat, Robert W Ariss, George V Moukarbel, Juan Carlos Plana Gomez, Savitri Fedson, Ajith Nair, Biykem Bozkurt, Hani Jneid

Faculty, Staff and Students Publications

BACKGROUND: Type 2 myocardial infarction (MI) is increasingly diagnosed in patients with heart failure (HF). A paucity of data exists pertinent to the contemporary prevalence and impact of type 2 MI in patients with HF. We studied the patient profiles and the prognostic impact of type 2 MI on outcomes of HF hospitalizations.

METHODS: The Nationwide Readmission Database 2018 was queried for patients with HF hospitalizations with and without type 2 MI. Baseline characteristics, inpatient outcomes, and 30-day all-cause readmissions between both cohorts were compared.

RESULTS: Of 1,072,674 primary HF hospitalizations included in the study, 28,813 (2.7%) had type 2 …

Atypical St-Segment-Elevation Myocardial Infarction Presentation In Patients With Covid-19 At A High-Volume Center In New York City, Miguel A Alvarez Villela, Ahmad Alkhalil, Michael A Weinreich, Jonathan Koslowsky, Shunsuke Aoi, M Azeem Latib

The Texas Heart Institute Journal

Atypical presentations of ST-segment-elevation myocardial infarction (STEMI) have been reported in patients who have COVID-19. We have seen this occurrence in our center in Bronx, New York, where multitudes of patients sought treatment for the coronavirus. We studied the prevalence of atypical STEMI findings among patients with COVID-19 who presented during the first 2 months of the pandemic.

Consistent with previous reports, 4 of our 10 patients with COVID-19 and STEMI had no identifiable culprit coronary lesion; rather, they often had diffuse ST-segment elevations on surface electrocardiograms along with higher levels of D-dimer and inflammatory markers. In contrast, 32 of …

Novel Pharmacomechanical Thrombolysis For Treating Intermediate-Risk Acute Pulmonary Embolism: The Bashir Endovascular Catheter, Maninder Singh, Austin Quimby, Vladimir Lakhter, Mohamad Al-Otaibi, Parth M Rali, Riyaz Bashir

The Texas Heart Institute Journal

No abstract provided.

Large-Bore Aspiration Thrombectomy: Catalyst For A Revolution In Treating Pulmonary Embolism, Thomas M Tu

The Texas Heart Institute Journal

No abstract provided.

Left Ventricular Ballooning Patterns In Recurrent Takotsubo Cardiomyopathy: A Systematic Review And Meta-Analysis Of Reported Cases, Ravi Korabathina, Jamie Porcadas, Kevin E Kip, Puja R Korabathina, Andrew D Rosenthal, Peter Wassmer

The Texas Heart Institute Journal

Recurrent takotsubo cardiomyopathy (TTC) and the clinical profiles and outcomes of patients have not been fully evaluated, nor has the effect of left ventricular ballooning pattern. After searching the medical literature for reports of patients with recurrent TTC, we identified 84 articles with 101 case descriptions. We divided the cases into those with only apical left ventricular ballooning patterns at recurrence (typical, n=60), and those with at least one midventricular or basal ballooning pattern (atypical, n=41). We then compared their clinical profiles and outcomes.

The groups were similar in terms of baseline demographic characteristics, presence and types of triggers, use …

Endovascular Treatment Of Acquired Atheromatous Postsubclavian Aortic Coarctation, Bhushan S Sonawane, Sreeja Pavithran, Kothandam Sivakumar

The Texas Heart Institute Journal

Coral reef aorta is a rare calcifying obstructive disease that involves the thoracoabdominal aorta. Similar presentations in the postsubclavian aorta may result in acquired atheromatous aortic coarctation leading to systemic hypertension and heart failure. The associated calcification makes surgical anatomic or extraanatomic bypass and thromboendarterectomy challenging. Extensive circumferential calcification often precludes endovascular intervention. We present the case of a 25-year-old man with an acquired atheromatous coarctation of the postsubclavian aorta who underwent successful endovascular treatment with use of a balloon-expandable covered stent.

Integrating Patient-Reported Outcomes Into Clinical Genetic Testing For Familial Hypercholesterolemia, Rachele M. Hendricks-Sturrup, Robert Block, Christine Y. Lu

Journal of Patient-Centered Research and Reviews

Patient-reported outcomes (PROs) and PRO measures (PROMs) are often used to help clinicians and researchers understand patients’ personal concerns, feelings, experiences, and perspectives following the implementation of an intervention. Notably, PROs and PROMs can inform health systems, health policy, and payers on the utility of clinical genetic testing based on each patient’s personal values, perspectives, and potential health behaviors subsequent to testing. In this topic synopsis, we discuss the underexplored role of and implications for PROs and PROMs following genetic testing for familial hypercholesterolemia (FH), an autosomal dominant genetic disorder of cholesterol metabolism that can lead to highly premature fatal …

A Novel Code Team Leader Card To Improve Leader Identification, Palak Shah, Vinod Havalad

Journal of Patient-Centered Research and Reviews

Prompt and clear code team leader identification is vital in effective cardiopulmonary resuscitation (CPR), and pediatric trainees often have limited experience in these scenarios. This project sought to develop a tangible object that provided clear leader identification and assisted in code team management and simulated team training. A Code Team Leader Card (CTLC) was designed to provide clear leader identification while simultaneously providing a cognitive aid via integration of pediatric advanced life support (PALS) algorithms. Additionally, CTLC served to occupy the leader’s hands to limit their ability to intervene on procedural tasks. The CTLC was incorporated into pediatric resident simulation …

Mental Health Or Cardiac Health. Is There A Reason To Choose? Cardiac Arrhythmias Induced By Atomoxetine And Methylphenidate, Gabriel Cismaru, Viorel Lupu

Journal of Mind and Medical Sciences

The current treatment of Attention Deficit Disorder and Attention Deficit with Hyperactivity consists mainly in the administration of Straterra (Atomoxetine) Concerta and Ritalin (Methylphenidate). The FDA warned that the products might increase systolic, diastolic blood pressure, and lead to ventricular arrhythmias. Arrhythmic events and sudden cardiac death were described in adults with preexistent heart disease. However, studies on children have failed to demonstrate a clear association between the arrhythmic events and these drugs, as demonstrated in adults. What should the attitude of the pediatric psychiatrist be towards the administration of these products? What examination should be made by the psychiatrist …

Hepatocellular Carcinoma With Extrahepatic Blood Supply From Right Renal Artery, Amir Humza Sohail, Ahmad Musa, Muhammad Salman Khan, Hassan Raza Hashmi, Basit Salam, Collin E M. Brathwaite

Department of Radiology

Extrahepatic blood supply is seen in around 17-27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70-83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any …

Phds/Cpt1b/Vdac1 Axis Regulates Long-Chain Fatty Acid Oxidation In Cardiomyocytes, Aude Angelini, Pradip K Saha, Antrix Jain, Sung Yun Jung, Randall L Mynatt, Xinchun Pi, Liang Xie

Faculty, Staff and Students Publications

Cardiac metabolism is a high-oxygen-consuming process, showing a preference for long-chain fatty acid (LCFA) as the fuel source under physiological conditions. However, a metabolic switch (favoring glucose instead of LCFA) is commonly reported in ischemic or late-stage failing hearts. The mechanism regulating this metabolic switch remains poorly understood. Here, we report that loss of PHD2/3, the cellular oxygen sensors, blocks LCFA mitochondria uptake and β-oxidation in cardiomyocytes. In high-fat-fed mice, PHD2/3 deficiency improves glucose metabolism but exacerbates the cardiac defects. Mechanistically, we find that PHD2/3 bind to CPT1B, a key enzyme of mitochondrial LCFA uptake, promoting CPT1B-P295 hydroxylation. Further, we …

Cellular Regeneration As A Potential Strategy To Treat Cardiac Conduction Disorders, Satadru K Lahiri, Mohit M Hulsurkar, Xander Ht Wehrens

Faculty, Staff and Students Publications

Loss of atrioventricular conduction system (AVCS) cells due to either inherited or acquired deficits leads to conduction diseases, which can deteriorate into fatal cardiac arrhythmias and sudden death. In this issue of the JCI, Wang et al. constructed a mouse model of atrioventricular block (AVB) by inducing AVCS cell-specific injury using the Cx30.2 enhancer to drive expression of diphtheria toxin fragment A. AVCS cell ablation in adult mice led to irreversible AVB. jkjkIn contrast, AVCS cell injury in neonatal mice was followed by spontaneous recovery in a subset of mice, revealing a limited postnatal time window during which the regeneration …

Ucp3 (Uncoupling Protein 3) Insufficiency Exacerbates Left Ventricular Diastolic Dysfunction During Angiotensin Ii-Induced Hypertension, Xu Chen, Sadia Ashraf, Nadia Ashraf, Romain Harmancey

Faculty, Staff and Student Publications

Background Left ventricular diastolic dysfunction, an early stage in the pathogenesis of heart failure with preserved ejection fraction, is exacerbated by joint exposure to hypertension and obesity; however, the molecular mechanisms involved remain uncertain. The mitochondrial UCP3 (uncoupling protein 3) is downregulated in the heart with obesity. Here, we used a rat model of UCP3 haploinsufficiency (ucp3

Beta-Blockers In The Critically Ill: Friend Or Foe?, Mourad H Senussi

Faculty, Staff and Students Publications

No abstract provided.

Endothelium-Specific Depletion Of Lrp1 Improves Glucose Homeostasis Through Inducing Osteocalcin, Hua Mao, Luge Li, Qiying Fan, Aude Angelini, Pradip K Saha, Cristian Coarfa, Kimal Rajapakshe, Dimuthu Perera, Jizhong Cheng, Huaizhu Wu, Christie M Ballantyne, Zheng Sun, Liang Xie, Xinchun Pi

Faculty, Staff and Students Publications

The vascular endothelium is present within metabolic organs and actively regulates energy metabolism. Here we show osteocalcin, recognized as a bone-secreted metabolic hormone, is expressed in mouse primary endothelial cells isolated from heart, lung and liver. In human osteocalcin promoter-driven green fluorescent protein transgenic mice, green fluorescent protein signals are enriched in endothelial cells lining aorta, small vessels and capillaries and abundant in aorta, skeletal muscle and eye of adult mice. The depletion of lipoprotein receptor-related protein 1 induces osteocalcin through a Forkhead box O -dependent pathway in endothelial cells. Whereas depletion of osteocalcin abolishes the glucose-lowering effect of low-density …

Cardiovascular Fellow-In-Training Feedback On Virtual And Simulator-Based Learning Experience During Covid-19 Pandemic In A Low To Middle Income Country - A Cross-Sectional Study, Pirbhat Shams, Intisar Ahmed, Hunaina Shahab, Zehra Kadani, Aisal Khan, Marvi Shams, Yawer Saeed, Syedah Saira Bokhari, Aamir Hameed Khan

Section of Cardiology

Background: COVID-19 pandemic has introduced us to a greater need of virtual learning platforms and has resulted in less clinical exposure for fellows-in-training. Virtual and simulator-based learning is not widely available in LMIC. It is imperative to analyze feedback of CV fellow-in-training regarding this mode of learning before large scale implementation.
Methodology: This was an observational study conducted between July-August 2020. A multicentered survey was conducted. Survey questionnaire was disseminated to FIT (fellow-in-training) via Google Forms. The questionnaire contained a total of 24 questions about virtual and simulator-based learning during the pandemic.
Results: A total of 68 FIT responded to …

A Simplified Approach To Identification Of Risk Status In Patients With Atherosclerotic Cardiovascular Disease, Aparna Sajja, Hsin-Fang Li, Kateri J Spinelli, Amir Ali, Salim S Virani, Seth S Martin, Ty J Gluckman

Faculty, Staff and Students Publications

OBJECTIVE: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) Blood Cholesterol Guideline recommendation to classify patients with atherosclerotic cardiovascular disease (ASCVD) as very high-risk (VHR) vs not-VHR (NVHR) has important implications for escalation of medical therapy. We aimed to define the prevalence and clinical characteristics of these two groups within a large multi-state healthcare system and develop a simpler means to assist clinicians in identifying VHR patients using classification and regression tree (CART) analysis.

METHODS: We performed a retrospective analysis of all patients in a 28-hospital US healthcare system in 2018. ICD-10 codes were used to define the ASCVD …

Sudden Cardiac Death In Athletes, Darren C Tsang, Mark S Link

The Texas Heart Institute Journal

No abstract provided.

Avoidance Of St-Segment-Elevation Myocardial Infarction Treatment For >1 Week Due To Covid-19 Fears, Rahul V Annabathula, Gregory J Sinner, Talal S Alnabelsi, Rachel P Goodwin, Vincent L Sorrell

The Texas Heart Institute Journal

During the coronavirus disease 2019 (COVID-19) pandemic, social distancing guidelines have negatively affected the care-seeking behavior of patients with chronic medical conditions, including those with cardiovascular disease. We report the case of a 60-year-old man with vague gastrointestinal symptoms who waited more than 1 week to seek treatment for fear of COVID-19 infection. On presentation at another hospital, he was found to have had an anterior myocardial infarction, and he underwent percutaneous coronary intervention to stent an occluded proximal left anterior descending coronary artery. Subsequently, the patient experienced refractory cardiogenic shock and, during his transfer to our hospital, refractory ventricular …

Cheyne-Stokes Respiration In A 17-Year-Old Boy Awaiting Heart Transplantation, Nooralam A Rai, Aliva De, Carin Lamm

The Texas Heart Institute Journal

Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children.

We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.

Medical And Device Therapy For Stroke Prevention In Patients With Atrial Fibrillation, Sophia Huang, Payam Safavi-Naeini, Abdi Rasekh

The Texas Heart Institute Journal

No abstract provided.

Endoleaks: Current Concepts And Treatments - A Narrative Review, Zia Ur Rehman

Department of Surgery Docs

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks (type I and III) have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks ( type II, IV and V) have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. …

Hemodynamic Outcomes After Valve-In-Valve Transcatheter Aortic Valve Replacement: A Single-Center Experience, R Yazan Kherallah, Srikanth Koneru, Zvonimir Krajcer, Ourania Preventza, Kathryn G Dougherty, Melissa L Mccormack, Briana T Costello, Stephanie Coulter, Neil E Strickman, Juan Carlos Plana Gomez, Ali Mortazavi, Jose G Díez, James J Livesay, Joseph S Coselli, Guilherme V Silva

Faculty, Staff and Students Publications

BACKGROUND: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis.

METHODS: We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and …

Continuous-Flow Left Ventricular Assist Device Support In Patients With Ischemic Versus Nonischemic Cardiomyopathy, Brendan P Chou, Andre Critsinelis, Harveen K Lamba, Gregory Long, Andrew B Civitello, Reynolds M Delgado, Subhasis Chatterjee

Faculty, Staff and Students Publications

To determine whether the cause of cardiomyopathy affects outcomes in patients who undergo continuous-flow left ventricular assist device support, we compared postimplant adverse events and survival between patients with ischemic and nonischemic cardiomyopathy. The inclusion criteria for the ischemic group were a history of myocardial infarction or revascularization (coronary artery bypass grafting or percutaneous coronary intervention), ≥75% stenosis of the left main or proximal left anterior descending coronary artery, or ≥75% stenosis of ≥2 epicardial vessels. From November 2003 through March 2016, 526 patients underwent device support: 256 (48.7%) in the ischemic group and 270 (51.3%) in the nonischemic group. …