Medical Specialties Commons^™

Gp91ds-Tat, A Selective Nadph Oxidase Peptide Inhibitor, Increases Blood Nitric Oxide (No) Bioavailability In Bind Limb Ischemia And Reperfusion (I/R), Sydney Walker, Tyler Galbreath, Qian Chen, Robert J. Barsotti, H. Patel, William Chau, Lindon H. Young

Research Day

I/R injury induces cell death and organ dysfunction in part due to a burst of reactive oxygen species that occurs upon the reintroduction of oxygen into the ischemic area, leading to endothelial dysfunction: decreased blood NO and increased hydrogen peroxide (H2O2 ) levels. We’ve previously shown in isolated rat hearts subjected to I/R injury, gp91ds-tat attenuated cardiac contractile dysfunction and reduced infarct size compared to controls presumably by the inhibition of NADPH oxidase induced superoxide release. Superoxide can quench NO via the formation of peroxynitrite and also be converted to H2O2 in blood. We attempted to confirm this hypothesis using …

Lean Body Mass May Explain Apparent Racial Differences In Carotid Intima-Media Thickness In Obese Children., Shahryar M. Chowdhury, Melissa H. Henshaw, Brad Friedman, J Philip Saul, Girish S. Shirali, Janet Carter, Bryana M. Levitan, Tom Hulsey

Manuscripts, Articles, Book Chapters and Other Papers

Background: Racial differences in carotid intima-media thickness (cIMT) have been suggested to be associated with the disproportionally high prevalence of cardiovascular disease in black adults. The objective of this study was to evaluate the effects of cardiovascular risk factors on the racial differences seen in cIMT in obese children.

Methods: Obese subjects aged 4 to 21 years were recruited prospectively. Height, weight, blood pressure, fasting insulin, glucose, lipid panel, high-sensitivity C-reactive protein, and body composition by dual-energy x-ray absorptiometry were obtained. B-mode carotid imaging was analyzed by a single blinded physician.

Results: A total of 120 subjects (46 white, 74 …

Medication Adherence And Intervention To Create Success In Hypertensive African Americans In A Rural Setting, Laneita Davis

DNP Projects

Hypertension is a chronic disease that has been a major problem in the African American community for decades. Although numerous research studies have examined interventions to combat this disease, there has been very little research published that focused on African Americans with hypertension in a rural setting. Rural residents experience many difficulties in accessing healthcare services. This difficult access is a disadvantage that results in higher morbidity and mortality rates compared to those of their urban counterparts. Being from a small town in Mississippi, I have witnessed first hand the many barriers that are encountered. Individuals who live in a …

The Odyssey Of Tavr From Concept To Clinical Reality, Alain G Cribier

The Texas Heart Institute Journal

No abstract provided.

Emergent Surgical Pulmonary Embolectomy In A Pregnant Woman: Case Report And Literature Review, Giovanni Saeed, Michael Möller, Jörg Neuzner, Rainer Gradaus, Werner Stein, Uwe Langebrake, Thomas Dimpfl, Meradjoddin Matin, Ali Peivandi

The Texas Heart Institute Journal

Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the …

Serum Levels Of Soluble Icam-1 In Children With Pulmonary Artery Hypertension, Melahat Melek Oguz, Ayse Deniz Oguz, Cihat Sanli, Ayhan Cevik

The Texas Heart Institute Journal

This prospective cross-sectional study attempted to determine both the usefulness of the serum intercellular adhesion molecule-1 (ICAM-1) as a biomarker for pulmonary artery hypertension secondary to congenital heart disease and the nature of this marker's association with catheter angiographic findings.

Our study included a total of 70 male and female children, comprising 30 patients with both pulmonary artery hypertension and congenital heart disease, 20 patients with congenital heart disease alone, and 20 healthy control subjects. Levels of ICAM-1 in plasma samples from all groups were measured by the enzyme-linked immunosorbent assay method. Cardiac catheterization was also performed in all patients. …

Cardiac Magnetic Resonance Imaging For The Investigation Of Cardiovascular Disorders Part 2: Emerging Applications, Ajit H Goenka, Hui Wang, Scott D Flamm

The Texas Heart Institute Journal

Cardiac magnetic resonance imaging has emerged as a robust noninvasive technique for the investigation of cardiovascular disorders. The coming-of-age of cardiac magnetic resonance—and especially its widening span of applications—has generated both excitement and uncertainty in regard to its potential clinical use and its role vis-à-vis conventional imaging techniques. The purpose of this evidence-based review is to discuss some of these issues by highlighting the current (Part 1, previously published) and emerging (Part 2) applications of cardiac magnetic resonance. Familiarity with the versatile uses of cardiac magnetic resonance will facilitate its wider clinical acceptance for improving the management of patients with …

The 1,000th Vad, The Great Rivalry, And The Grand Experiment Of The Texas Medical Center, Todd K Rosengart

The Texas Heart Institute Journal

No abstract provided.

Systemic Effects Of Intracoronary Nitroglycerin During Coronary Angiography In Children After Heart Transplantation, Diego A Lara, Mary K Olive, James F George, Robert N Brown, Waldemar F Carlo, Edward V Colvin, Brad L Steenwyck, F Bennett Pearce

The Texas Heart Institute Journal

Coronary spasm during coronary angiography for vasculopathy in children can be prevented by the intracoronary administration of nitroglycerin. We reviewed the anesthesia and catheterization reports and charts for pediatric transplant recipients who underwent angiography from 2005 through 2010. Correlation analysis was used to study the relation of post-injection systolic blood pressure (SBP) to nitroglycerin dose. Forty-one angiographic evaluations were performed on 25 patients (13 male and 12 female). Mean age was 9.9 ± 3.2 years (range, 3.3–16.1 yr). The mean total dose of nitroglycerin was 2.93 ± 1.60 µg/kg (range, 1–8 µg/kg).

There was a significant drop between the baseline …

Repair Of Bicuspid Aortic Valve In The Presence Of Endocarditis And Leaflet Perforation, William D T Kent, Hadi D Toeg, Jehangir J Appoo

The Texas Heart Institute Journal

Aortic valve repair can be a good option in younger patients who have severe aortic regurgitation. A systematic, disease-directed approach can simplify repair. This case report describes how a simplified approach can be successfully applied to complex pathologic conditions of the aortic valve.

A 49-year-old man with a bicuspid aortic valve and a history of endocarditis presented with severe aortic regurgitation and evidence of recurrent infection. Intraoperatively, we found congenital and degenerative aortic anatomy with endocarditis and perforation. We performed aortic valve repair to enable leaflet coaptation and to adjust the coaptation height. After 24 months, the patient remained well, …

Papillary Muscle Repositioning As A Subvalvular Apparatus Preservation Technique In Mitral Stenosis Patients With Normal Left Ventricular Systolic Function, Imthiaz Manoly, Dimos Karangelis, Nicola Viola, Marcus Haw

The Texas Heart Institute Journal

Surgically repairing Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a challenge if there are variations in the origin of the anomalous artery. We report the successful repair of this congenital abnormality in a 19-year-old woman who presented with an acute anterior myocardial infarction. The anomalous artery originated from the anterior-facing sinus of the pulmonary artery, which precluded typical repair by direct reimplantation or fashioning an intrapulmonary tunnel. We created an extrapulmonary tunnel, using a strip of pulmonary artery anteriorly and an aortic flap posteriorly. Three years postoperatively, the anastomosis was patent and the …

Papillary Muscle Repositioning As A Subvalvular Apparatus Preservation Technique In Mitral Stenosis Patients With Normal Left Ventricular Systolic Function, Gokhan Lafci, Kerim Cagli, Omer Faruk Cicek, Kemal Korkmaz, Osman Turak, Alper Uzun, Adnan Yalcinkaya, Adem Diken, Eren Gunertem, Kumral Cagli

The Texas Heart Institute Journal

Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function.

We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups.

The …

Cardiac Magnetic Resonance Imaging For The Investigation Of Cardiovascular Disorders Part 1: Current Applications, Ajit H Goenka, Scott D Flamm

The Texas Heart Institute Journal

Cardiac magnetic resonance imaging is a robust noninvasive technique for investigating cardiovascular disorders. The evolution of cardiac magnetic resonance and its widening span of diagnostic and prognostic applications have generated excitement as well as uncertainty regarding its potential clinical use and its role vis-à-vis conventional imaging techniques. The purpose of this evidence-based review is to discuss some of these issues by highlighting the current (Part 1) and emerging (Part 2) applications of cardiac magnetic resonance. Familiarity with the versatility and usefulness of cardiac magnetic resonance will facilitate its wider clinical acceptance for improving the management of cardiovascular disorders.

Galectin-1 In Early Acute Myocardial Infarction, Suhail Al-Salam, Satwat Hashmi

Department of Biological & Biomedical Sciences

Myocardial infarction (MI) is the most serious manifestation of coronary artery disease and the cause of significant mortality and morbidity worldwide. Galectin-1(GAL-1), a divalent 14.5-kDa protein, is present both inside and outside cells, and has both intracellular and extracellular functions. Hypoxia inducible factor-1 alpha (HIF-1α) is a transcription factor mediating early and late responses to myocardial ischemia. Identification of the pattern of expression of GAL-1 and HIF-1α in the heart during the first 24 hours following acute MI will help in understanding early molecular changes in this event and may provide methods to overcome serious complications. Mouse model of MI …

Maternal Biomarkers Of Endothelial Dysfunction And Preterm Delivery, Xinhua Chen, Theresa O Scholl

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Endothelial dysfunction is key to the development of atherosclerosis. Preterm delivery foreshadows later maternal cardiovascular disease (CVD), but it is not known if endothelial dysfunction also occurs. We prospectively measured circulating biomarkers of endothelial dysfunction in pregnant women with preterm or term delivery.

METHODS: We conducted a case-control study nested within a large prospective epidemiological study of young, generally healthy pregnant women. Women who delivered preterm (gestation, n = 240) and controls who delivered at term (n = 439) were included. Pregnancies complicated by preeclampsia were analyzed separately. Circulating endothelial dysfunction biomarkers included soluble intercellular adhesion molecule-1 (sICAM-1), vascular …

A Systematic Review Of Internet-Based Worksite Wellness Approaches For Cardiovascular Disease Risk Management: Outcomes, Challenges & Opportunities, Ehimen Aneni, Lara Roberson, Arthur Agatston, Theodore Feldman, Maribeth Rouseff, Thinh Tran, Khurram Nasir

All Publications

No abstract provided.

The Effects Of Dihydrobiopterin And Tetrahydrobiopterin On Hydrogen Peroxide And Nitric Oxide Release During Extracorporeal Shockwave Lithotripsy (Eswl), Brittany Deiling

PCOM Biomedical Studies Student Scholarship

ESWL is an effective, non-invasive therapy utilized to fragment stones in the kidney and subsequently be cleared in the urinary tract. Although lithotripsy provides a safer alternative to invasive treatments for removing stones, ESWL may cause vasoconstriction after ESWL treatment, reducing renal blood flow, which can cause kidney damage leading to acute to chronic hypertension clinically. This may be due to kidney vascular endothelial dysfunction, which is characterized as increased oxidative stress and decreased endothelial nitric oxide synthase (eNOS)-derived nitric oxide (NO) bioavailability. We hypothesized that ESWL would decrease NO and increase hydrogen peroxide (H₂O₂) in …

Assessing Prevalence Of Known Risk Factors In A Regional Central Kentucky Medical Center Heart Failure Population As An Approach To Assessment Of Needs For Development Of A Program To Provide Targeted Services To Reduce 30 Day Readmissions, Christeen Ivy Broaddus

DNP Projects

Abstract

Objectives:

1. Determine demographic, physiologic, and laboratory characteristics at time of admission of the heart failure (HF) population in a regional acute care facility in Central Kentucky through review of patient electronic medical records.
2. Determine which HF population characteristics are significantly associated with readmissions to the hospital.
3. Provide identification of the statistically significant common characteristics of the HF population to this facility so that they may work towards development of an electronic risk for readmission predictive instrument.

Design: Retrospective chart review.

Setting: Regional acute care facility in Central Kentucky.

Participants: All patients (n = 175) with a diagnosis or history …

Examining The Effect Of Race On The Relationship Between Posttraumatic Stress Disorder And Metabolic Syndrome In Women, Leia Harper

Theses and Dissertations

Posttraumatic stress disorder (PTSD) is a psychiatric condition affecting approximately 8% of the adult U.S. population with rates twice as high in women than men. Increasingly, evidence has suggested a close relationship between PTSD and increased risk of metabolic diseases. However, the literature on PTSD and metabolic disease risk factors has been limited by the lack of investigation of the potential influence of race on this relation. The current study examined the possible effect of race on the relation between PTSD and metabolic risk. Data for this study were provided from sample of that included 50 African American women and …

Predictors Of Disease Progression In Pediatric Dilated Cardiomyopathy., Kimberly M. Molina, Peter Shrader, Steven D. Colan, Seema Mital, Renee Margossian, Lynn A. Sleeper, Girish S. Shirali, Piers Barker, Charles E. Canter, Karen Altmann, Elizabeth Radojewski, Elif Seda Selamet Tierney, Jack Rychik, Lloyd Y. Tani, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

Background: Despite medical advances, children with dilated cardiomyopathy (DCM) remain at high risk of death or need for cardiac transplantation. We sought to identify predictors of disease progression in pediatric DCM.

Methods and results: The Pediatric Heart Network evaluated chronic DCM patients with prospective echocardiographic and clinical data collection during an 18-month follow-up. Inclusion criteria were age <22 years and DCM disease duration >2 months. Patients requiring intravenous inotropic/mechanical support or listed status 1A/1B for transplant were excluded. Disease progression was defined as an increase in transplant listing status, hospitalization for heart failure, intravenous inotropes, mechanical support, or death. Predictors of disease progression were identified using …

New Oral Anticoagulants Are Not Superior To Warfarin In Secondary Prevention Of Stroke Or Transient Ischemic Attacks, But Lower The Risk Of Intracranial Bleeding: Insights From A Meta-Analysis And Indirect Treatment Comparisons, Partha Sardar, Saurav Chatterjee, Wen-Chih Wu, Edgar Lichstein, Joydeep Ghosh, Shamik Aikat, Debabrata Mukherjee

Internal Medicine Faculty Publications

PURPOSE: Patients with Atrial Fibrillation (AF) and prior stroke are classified as high risk in all risk stratification schemes. A systematic review and meta-analysis was performed to compare the efficacy and safety of New Oral Anticoagulants (NOACs) to warfarin in patients with AF and previous stroke or transient ischemic attack (TIA).

METHODS: Three randomized controlled trials (RCTs), including total 14527 patients, comparing NOACs (apixaban, dabigatran and rivaroxaban) with warfarin were included in the analysis. Primary efficacy endpoint was ischemic stroke, and primary safety endpoint was intracranial bleeding. Random-effects models were used to pool efficacy and safety data across RCTs. RevMan …

Seventeenth Annual Scientific Meeting Institute Of Cardiovascular Science And Medicine

Journal of the Hong Kong College of Cardiology

No abstract provided.

A Coronary Rupture In The Left Anterior Descending Artery At Second Diagonal Artery Bifurcation Level In An Intervention With A Tryton Side Branch Stent, Muhammed Hakan Tas, Ziya Simsek, Yavuzer Koza, Zakir Lazoglu

Journal of the Hong Kong College of Cardiology

Percutaneous coronary intervention (PCI) for bifurcation lesions (BLs) is considered high risk due to increased procedural adverse events when compared to non-bifurcation lesion. Dedicated bifurcation stents, specifically designed to allow minimally traumatic implantation in the main vessel and/or side branch while providing adequate scaffolding of the side branch ostium may offer an advantage over utilization of conventional stents. Coronary perforation as a complication of PCI is a rare but potentially lethal complication that is associated with a high rate of morbidity. Coronary artery perforation during PCI has been reported repeatedly. To our best knowledge perforation in a BL, PCI with …

Cardiac Fibroblast-Dependent Extracellular Matrix Accumulation Is Associated With Diastolic Stiffness In Type 2 Diabetes., Kirk R. Hutchinson, C. Kevin Lord, T. Aaron West, James A. Stewart

CAS Publications

Cardiovascular complications are a leading cause of death in patients with type 2 diabetes mellitus (T2DM). Diastolic dysfunction is one of the earliest manifestations of diabetes-induced changes in left ventricular (LV) function, and results from a reduced rate of relaxation and increased stiffness. The mechanisms responsible for increased stiffness are not completely understood. Chronic hyperglycemia, advanced glycation endproducts (AGEs), and increased levels of proinflammatory and profibrotic cytokines are molecular pathways known to be involved in regulating extracellular matrix (ECM) synthesis and accumulation resulting in increased LV diastolic stiffness. Experiments were conducted using a genetically-induced mouse model of T2DM generated by …

The Effect Of Heart Failure Education On Reducing Readmissions, Mayola Lara Villarruel

Evidence-Based Practice Project Reports

Management of heart failure is a significant financial challenge for the health care industry, costing approximately $33.2 billion annually. Common reasons for preventable heart failure readmissions include inadequate discharge education and lack of self-care and health management activities. Education at discharge is a vital component of improving heart failure outcomes. Following a review of the literature, high quality evidence supports that heart failure education should focus on medication adherence, sodium and fluid restriction, daily weights, activity tolerance, identification of deteriorating signs and symptoms of heart failure, and smoking cessation. The purpose of this EBP project was to reduce heart failure …

Redefining Myocardial Infarction: What Is New In The Esc/Accf/Aha/Whf Third Universal Definition Of Myocardial Infarction?, Hani Jneid, Mahboob Alam, Salim S. Virani, Biykem Bozkurt

Office of the Provost

Myocardial infarction (MI) is a major cause of mortality and morbidity worldwide. Each year, an estimated 785,000 persons will have a new MI in the United States alone, and approximately every minute an American will succumb to one.1 In addition, MI has major psychological and legal implications for patients and the society and is an important outcome measure in research studies. The prevalence of MI provides useful data regarding the burden of coronary artery disease and offers insight into health care planning, policy, and resource allocation. The importance of accurately and reproducibly defining MI is therefore self-evident. The Third Universal …

Corrigendum For “Acute Aortic Valve Rupture From Infective Endocarditis”, Julia Ansari, Gurkaran Singh Garcha, Henry Huang, Faisal G. Bakaeen, Salim S. Virani, Hani Jneid

Office of the Provost

No abstract provided.

De-Branching Of The Aortic Arch During Thoracic Endovascular Aortic Repair, James K. Wu Md, Caitlin O'Connor Bs, Timothy S. Misselbeck, Theodore G. Phillips Md

Department of Surgery

No abstract provided.

Acute Aortic Valve Rupture From Infective Endocarditis After Transrectal Prostate Biopsy: A Call To Revise The Aha Guidelines For Prevention Of Infective Endocarditis, Julia Ansari, Gurkaran Singh Garcha, Henry Huang, Faisal G. Bakaeen, Salim S. Virani, Hani Jneid

Office of the Provost

We describe the case of a 63-year-old man with a known murmur who presented with a 4-month history of intermittent fever and a progressive reduction in energy level after a transrectal prostate biopsy (TRPB). He subsequently presented with acute heart failure secondary to aortic valve cusp rupture caused by endocarditis and underwent urgent aortic valve surgery. The 2008 American College of Cardiology/American Heart Association Guideline update on infective endocarditis has narrowed the use of antibiotic prophylaxis before most accepted dental procedures and continues to recommend against prophylaxis before genitourinary or gastrointestinal procedures. In contrast, the American Urological Association recommends the …

Loss Of Dystrophin Staining In Cardiomyocytes: A Novel Method For Detection Early Myocardial Infarction, Satwat Hashmi, Suhail Al-Salam

Department of Biological & Biomedical Sciences

Myocardial infarction (MI) is the most frequent diagnosis made in majority of sudden death cases subjected to clinical and medicolegal autopsies. When sudden death occurs at a very early stage of MI, traditional macroscopic examination, or histological stains cannot easily detect the myocardial changes. For this reason we propose a new method for detecting MI at an early stage. Murine model of MI was used to induce MI through permanent ligation of left anterior descending branch of left coronary artery. Five groups of C57B6/J mice were used for inducing MI, which includes 20 minutes, 30 minutes, one hour, four hours …