Medical Specialties Commons^™

Pre-Participation Physical Examination: Are Current Cardiovascular Recommendations Enough?, Steven Jacob Pietrusza

Physician Assistant Scholarly Project Papers

Inclusion of screening electrocardiograms (EKGs) during pre-participation physical examination has been a topic of debate for some time. There is unquestioned usefulness in the ability of a well-trained health care provider in using EKG to identify cardiac abnormalities. Further, there have been several contemporary EKG criteria published that increase specificity and sensitivity of detection of disease. However, these criteria do not account for athletes less than 14 years of age, and that demographic represents a large portion of patients seeking pre-participation screenings in the United States. The lack of research into pediatric cardiac remodeling secondary to activity, coupled with the …

Health Systems Readiness For Adopting Mhealth Interventions For Addressing Non-Communicable Diseases In Low- And Middle-Income Countries: A Current Debate, Anam Shahil Feroz, Muhammad Masood Kadir, Sarah Saleem

Community Health Sciences

In low-and-middle-income countries, epidemiologic transition is taking place very rapidly from communicable diseases to non-communicable diseases. NCDs mortality rates are increasing faster and nearly 80% of NCDs deaths occur in LMICs. Existing weak health systems of LMICs are undergoing a devastating human and economic toll as a result of increasing treatment costs and losses to productivity from NCDs. At the same time, the increasing penetration of mobile phone technology and the spread of cellular network and infrastructure have led to the introduction of the mHealth field. While mHealth field offers a great promise to prevent and control non-communicable diseases in …

Effects Of The Na-Cl Co-Transporter (Ncc) In Western Diet Induced Metabolic And Cardiac Dysfunction, Zachary S. Cutter

Theses and Dissertations

Interleukin-18 (IL-18) is a pro-inflammatory cytokine known to be involved in maintaining metabolic homeostasis; however, also capable of inducing cardiac dysfunction. Additionally, IL-18, has been shown to bind to a novel receptor, the Na-Cl Co-transporter (NCC). We hypothesized that NCC mediates IL-18 metabolic and cardiac signaling in mice. Using male C57BL/6J mice, we compared the metabolic and cardiac function changes after at least 8 weeks of high-saturated fat high sugar diet (Western Diet) in NCC knockout (NCCKO), IL-18 knockout (IL-18KO), and wild-type mice. We show that NCCKO mice have significantly increased body weight gain from baseline, no difference in fasting …

Aging, Inflammation, And Gut Microbiota In Mice, Jody Demeo

Honors Projects

Inflammation and gut microbiota are two areas of study that can be linked to aging in the body. As a person ages, systemic inflammation tends to increase, and changes in microbiota in the gastrointestinal system occur as well.

Iron Reduction Response And Demographic Differences Between Diabetics And Non-Diabetics With Cardiovascular Disease Entered To A Controlled Clinical Trial, Leo Zacharski, Galina Shamayeva, Bruce Chow

Dartmouth Scholarship

Iron-catalyzed oxygen free radical-induced oxidative stress mediates the pathogenesis of diabetes and cardiovascular disease (CVD). Diabetics (n=473) and non-diabetics (n=804) with CVD entered to a randomized trial of iron (ferritin) reduction by calibrated phlebotomy (www.clinicaltrials.gov, Identifier NCT00032357) had comparable iron measures at entry but diabetics had greater burden of CVD and comorbidities, lower hemoglobin and hematocrit levels, and higher glucose levels than non-diabetics. Entry iron measures were lower in diabetics on hypoglycemic therapy compared to diabetics untreated previously. Diabetics and non-diabetics had comparable iron measures during follow-up. Loess analysis of paired ferritin and hemoglobin, and paired ferritin and glucose levels …

Structural Insights Into The Potency Of Sk Channel Positive Modulators, Young-Woo Nam, Razan Orfali, Tingting Liu, Kunqian Yu, Meng Cui, Heike Wulff, Miao Zhang

Pharmacy Faculty Articles and Research

Small-conductance Ca2+-activated K+ (SK) channels play essential roles in the regulation of cellular excitability and have been implicated in neurological and cardiovascular diseases through both animal model studies and human genetic association studies. Over the past two decades, positive modulators of SK channels such as NS309 and 1-EBIO have been developed. Our previous structural studies have identified the binding pocket of 1-EBIO and NS309 that is located at the interface between the channel and calmodulin. In this study, we took advantage of four compounds with potencies varying over three orders of magnitude, including 1-EBIO, NS309, SKS-11 (6-bromo-5-methyl-1H-indole-2,3-dione-3-oxime) and …

Comparative Effectiveness And Safety Of Empagliflozin On Cardiovascular Mortality And Morbidity In Adults With Type 2 Diabetes, Wilbert S. Aronow, Tatyana Shamliyan

NYMC Faculty Publications

Background: Based on a single placebo-controlled randomized clinical trial, empagliflozin is licensed to reduce cardiovascular death in diabetes and comorbid cardiovascular disease. Methods: We examined the comparative effectiveness of empagliflozin on mortality and cardiovascular morbidity in type 2 diabetes. We conducted random-effects direct frequentist meta-analyses of aggregate data and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to May 2017 identified 11 meta-analyses, multiple publications, and unpublished data from 29 randomized controlled trials (RCTs). Results: Empagliflozin reduces all-cause mortality [relative …

Masked Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Serum Microrna-27b As A Screening Biomarker For Left Ventricular Hypertrophy, Yan Wang, Shuyan Chen, Yanhong Gao, Song Zhang

The Texas Heart Institute Journal

MicroRNA-27b (miR-27b) is frequently upregulated in pressure-overloaded hypertrophic hearts. The clinical implications of aberrant circulating miR-27b in the diagnosis and management of left ventricular hypertrophy warrant study. We investigated whether serum miR-27b is a biomarker for left ventricular hypertrophy (LVH).

We used stem-loop reverse-transcription quantitative polymerase chain reaction techniques to analyze serum miR-27b levels in 200 hypertensive patients with LVH, 100 hypertensive patients without LVH, and 100 healthy volunteers. We found that serum miR-27b levels were significantly higher in the hypertensive patients with LVH than in the hypertensive patients without LVH and in the healthy volunteers. Upon receiver operating characteristic …

A Blueprint For Life And Love, Marilyn Todd

The Texas Heart Institute Journal

No abstract provided.

Bioresorbable Scaffolds In Spontaneous Coronary Artery Dissection: Long-Term Follow-Up In 4 Patients, Santiago Jesús Camacho Freire, Antonio Enrique Gómez Menchero, Jessica Roa Garrido, Javier León Jiménez, Rosa Cardenal Piris, José Francisco Díaz Fernández

The Texas Heart Institute Journal

Spontaneous coronary artery dissection is a rare condition, and diagnosis and treatment are challenging among patients who present with acute coronary syndrome. Typically, the condition affects young females who have no underlying atherosclerotic disease. To date, few cases of bioresorbable scaffold implantation for the treatment of spontaneous coronary artery dissection have been reported. Therefore, we describe the cases of 4 patients whom we treated with scaffolds. We evaluated the long-term results by using intravascular ultrasound and optical coherence tomographic scanning.

Recurrent Biatrial Myxoma In A 41-Year-Old Woman After Left Atrial Myxoma Resection, Xiaoming Jia, Anjali Kohli, Jane Jarjour, Chung-Jiah Justin Chen, Brendan Gilmore, Rashed Tabbaa, Edward Lee Poythress

The Texas Heart Institute Journal

Bilateral recurrence of atrial myxoma has been reported only a few times. We describe the case of a 41-year-old woman who had undergone left atrial myxoma resection and presented 9 years later with myxomas in both atria. The patient underwent successful resection of both masses with resolution of symptoms. We discuss the phenomenon of recurrent biatrial myxoma.

Multimodal Imaging Of Anomalous Left Coronary Artery From The Pulmonary Artery In A 75-Year-Old Woman, Margaret M Fuchs, Rachel J Le, Michael W Cullen, Joseph J Maleszewski, Naser M Ammash

The Texas Heart Institute Journal

Anomalous origin of the left coronary artery from the pulmonary artery is rare and typically results in mitral regurgitation, ventricular arrhythmias, heart failure, and sudden death. The condition most often manifests itself in early childhood, but some individuals are diagnosed much later. We describe the case of a 75-year-old woman with heart failure in whom stepwise multimodal imaging revealed anomalous origin of the left coronary artery from the pulmonary artery.

Assessment Of Chronic Disease To Determine Appropriateness Of Implantable Cardioverter-Defibrillator Therapy, Bilal M. Omery, Maharaj Singh, Randy S. Turkel, Robyn Shearer, Arshad Jahangir, M. Eyman Mortada, Jasbir S. Sra, Indrajit Choudhuri

Journal of Patient-Centered Research and Reviews

Background: Implantable cardioverter-defibrillator (ICD) therapy is considered appropriate when a patient is felt to have a reasonable expectation of 1-year survival. Chronic diseases have been estimated to be associated with greater than 10% annual mortality and may reduce benefits of ICD therapy. Frailty has been estimated to be associated with greater than 20% annual mortality and has been suggested to contraindicate ICD therapy.

Purpose: Determine a risk score that may identify patients in whom ICD implantation may not be appropriate.

Methods: Patients who received an ICD for primary and secondary prevention from 2008 through 2013 at the Aurora Health Care …

Sensitivity Of Current Methods For Diagnosing And Documenting Metabolic Syndrome Within A Large Community-Based Health Care System, Tiffany A. Mullen, Danielle M. Greer, Jennifer T. Fink, Renee E. Walker

Journal of Patient-Centered Research and Reviews

Background: Metabolic syndrome (MetS) is a constellation of metabolic conditions, including abdominal obesity, high blood pressure, high triglyceride level, low high-density-lipoprotein level and high fasting blood glucose level, that increase the risk of developing chronic health conditions. Various combinations of diagnostic criteria have been proposed, including those by the National Cholesterol Education Program Adult Treatment Panel III (ATP III), World Health Organization (WHO) and International Diabetes Foundation (IDF), among others. However, inconsistent use of diagnostic criteria and inadequate scientific evidence supporting use of specific criteria are current problems in health care.

Purpose: Quantify the prevalence of MetS diagnosis within the …

Mechanisms Of Left Ventricular Thrombus Formation In Heart Failure With Reduced Ejection Fraction: Novel Insights From Two-Dimensional Speckle Tracking Echocardiography, Dhruv Chawla, Tracy Hammonds, Tadele Mengesha, Matt Umland, Khawaja Afzal Ammar, Vinay Thohan

Journal of Patient-Centered Research and Reviews

Background: Patients suffering from heart failure with reduced ejection fraction (HFrEF) are at increased risk for left ventricular (LV) thrombus and subsequent thromboembolism, yet anticoagulation is not routinely recommended for left ventricular ejection fraction (LVEF) alone. We sought to determine the role of two-dimensional speckle tracking echocardiography (2D-STE) to quantify regional changes in cardiac function associated with LV thrombus, which may prospectively guide anticoagulation.

Purpose: Help enable cardiovascular clinicians to use 2D-STE to evaluate regional strain patterns among patients with HFrEF with and without LV thrombus. Our results suggest that statistically lower regional longitudinal strain patterns in a well-matched cohort …

Hypertension Highlights During 2016, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Predictors Of High-Sensitivity Cardiac Troponin T Elevation In Patients With Acute Paroxysmal Supraventricular Tachycardia And Ischemic Heart Disease, Mehdi Sayadnik, Akbar Shafiee, Yaser Jenab, Arash Jalali, Saeed Sadeghian

The Texas Heart Institute Journal

We studied the predictors and patterns of high-sensitivity cardiac troponin T (hs-cTnT) elevation in patients with paroxysmal supraventricular tachycardia (PSVT) in the presence and absence of ischemic heart disease.

During calendar year 2013, we enrolled 70 of 72 consecutive adult patients with PSVT who presented at our center within 4 hours after the onset of tachycardia. On the basis of increased hs-cTnT at either of 2 initial measurements, we divided patients into groups (hs-cTnT–positive and hs-cTnT–negative), to study the predictors of enzyme elevation. We then divided the hs-cTnT–positive patients into 2 groups—those with and those without ischemic heart disease—and compared …

Left Circumflex Coronary Artery As The Culprit Vessel In St-Segment-Elevation Myocardial Infarction, Diab Ghanim, Fabio Kusniec, Wadi Kinany, Dahud Qarawani, David Meerkin, Khaled Taha, Offer Amir, Shemy Carasso

The Texas Heart Institute Journal

The prevalence of the left circumflex coronary artery (LCx) as the culprit vessel in ST-segment-elevation myocardial infarction (STEMI) is reportedly lowest among that of the 3 main epicardial arteries, and has not been described for non-STEMI (NSTEMI) and stable angina pectoris. We sought to define the distribution of culprit arteries in these clinical presentations and suggest mechanisms for the differences.

We reviewed 189 coronary angiograms of patients with STEMI, 203 with NSTEMI, and 548 with stable angina (n=940), and compared distributions of stenotic and culprit coronary arteries (lesions prompting intervention).

Obstructive coronary lesions (≥50% narrowing) were more prevalent in the …

The Rise And Fall Of Estrogen Therapy: Is Testosterone For "Manopause" Next?, Briana T Costello, Keri Sprung, Stephanie A Coulter

The Texas Heart Institute Journal

No abstract provided.

Management Of Chronic Venous Disease, Michael Mcardle, Eduardo A Hernandez-Vila

The Texas Heart Institute Journal

No abstract provided.

A Blessing, Jeremy A Ross

The Texas Heart Institute Journal

No abstract provided.

Use Of Dark Chocolate For Diabetic Patients: A Review Of The Literature And Current Evidence, Syed Raza Shah, Richard Alweis, Najla Issa Najim, Amin Muhammad Dharani, Muhammad Ahmed Jangda, Maira Shahid, Ahmed Nabeel Kazi, Syed Arbab Shah

Internal Medicine Faculty Publications

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin …

Radiation-Free Cmr Diagnostic Heart Catheterization In Children., Kanishka Ratnayaka, Joshua P Kanter, Anthony Z Faranesh, Elena K Grant, Laura J Olivieri, Russell R Cross, Ileen F Cronin, Karin S Hamann, Adrienne E Campbell-Washburn, Kendall J O'Brien, Toby Rogers, Michael S Hansen, Robert J Lederman

Pediatrics Faculty Publications

BACKGROUND: Children with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right heart catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety.

METHODS: We performed 50 CMR fluoroscopy guided comprehensive transfemoral right heart catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac catheterization. CMR guided …

The Effect Of Health Insurance Coverage And The Doctor-Patient Relationship On Health Care Utilization In High Poverty Neighborhoods, Destini Smith, Alan Akira, Kenneth Hudson, Andrea Hudson, Marcellus Hudson, Marcus Mitchell, Errol Crook

School of Medicine and Health Sciences Student Works

African Americans have higher rates of mortality than whites who are the same age and sex. We hypothesize that in low socioeconomic status neighborhoods, having health insurance coverage and a regular health care provider increases the likelihood of receiving diagnostic tests for cardiovascular disease and diabetes. We use data from a random two-stage cluster sample of 230 adults living in high poverty census tracts to examine the effects of insurance coverage and having a regular doctor on the likelihood receiving diagnostic tests for high cholesterol, high blood sugar, and blood pressure. We find that health insurance coverage increases the odds …

Correlation Between Electrocardiographic Changes And Coronary Findings In Patients With Acute Myocardial Infarction And Single-Vessel Disease, Abdallah Sanaani, Srikanth Yandrapalli, George P. Jolly, R Paudel, Howard Cooper, Wilbert Aronow

NYMC Faculty Publications

BACKGROUND: Correlation of ST-segment elevation on the 12-lead electrocardiogram (ECG) with the expected affected coronary territory is established in patients with ST-elevation myocardial infarction (STEMI). In patients with non-ST-elevation myocardial infarction (NSTEMI), correlation of ischemic ECG abnormalities with the affected coronary territory has not been well-established. We sought to investigate the correlation of electrocardiographic abnormalities with the location of 1-vessel obstructive coronary artery disease (CAD) in patients with both STEMI and NSTEMI. METHODS: In this retrospective study, the charts of all patients referred for coronary angiography in 2012 were reviewed. Patients with a single obstructive coronary artery plus angina-equivalent symptoms …

Improving Cardiology Patient Flow In Nuclear Medicine, Kelly Haar, Hannah Sullivan, Kathryn Laverdiere, Nuclear Medicine Department, Haley Pelletier, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

At baseline, a nuclear medicine department found it difficult to complete cardiac stress tests within scheduled times. Using the performance improvement process, a nuclear medicine department looked to improve patient experience related to wait times for this test.

Two goals were identified and a root cause analysis was initiated. After identifying some process issues, two KPIs were developed to address them.

A root cause analysis identified some processing issues and two KPIs were instituted to address them.

As a result, one outcome was to hire an additional physician assistant to address the barrier of inadequate cardiology coverage. Next steps include …

Influence Of Differential Calcification In The Descending Thoracic Aorta On Aortic Pulse Pressure, Mirza Mujadil Ahmad, Syed Haris Ahmed Pir, Mustafa Noor Muhammad, Sharmeen Hussaini, Immad Arif Kiani, Mirza Nubair Ahmad, Imaad Razzaque, Muhammad Nabeel Syed, Rafath Ullah, Suhail Allaqaband, Anjan Gupta, Steven C. Port, Khawaja Afzal Ammar

Journal of Patient-Centered Research and Reviews

Purpose: Multiple studies have shown pulse pressure (PP) to be a strong predictor of aortic calcification. However, no studies are available that correlate PP with aortic calcification at the segmental level.

Methods: We identified 37 patients with aortic PP measured during cardiac catheterization. Their noncontrast chest computed tomography scans were evaluated for the presence of calcium in different segments (ascending aorta, arch of aorta [arch], descending aorta) and quantified. Patients with calcification (Calcified Group A) were compared against patients without calcification (Noncalcified Group B) in terms of PP, calcification and compliance.

Results: The mean of the total calcium score was …

Targeting Hepatic Heparin-Binding Egf-Like Growth Factor (Hb-Egf) Induces Anti-Hyperlipidemia Leading To Reduction Of Angiotensin Ii-Induced Aneurysm Development, Seonwook Kim, Lihua Yang, Seongu Kim, Richard G. Lee, Mark J. Graham, Judith A. Berliner, Aldons J. Lusis, Lei Cai, Ryan E. Temel, Debra L. Rateri, Sangderk Lee

Saha Cardiovascular Research Center Faculty Publications

Objective

The upregulated expression of heparin binding EGF-like growth factor (HB-EGF) in the vessel and circulation is associated with risk of cardiovascular disease. In this study, we tested the effects of HB-EGF targeting using HB-EGF-specific antisense oligonucleotide (ASO) on the development of aortic aneurysm in a mouse aneurysm model.

Approach and results

Low-density lipoprotein receptor (LDLR) deficient mice (male, 16 weeks of age) were injected with control and HB-EGF ASOs for 10 weeks. To induce aneurysm, the mice were fed a high fat diet (22% fat, 0.2% cholesterol; w/w) at 5 week point of ASO administration and infused with angiotensin …

Risk Of Respiratory Syncytial Virus Hospitalization In The First And Second Years Of Life In Pediatric Patients With Congenital Heart Disease, Deborah Friedman, Pierre Wong

NYMC Faculty Publications

No abstract provided.