Medical Specialties Commons^™

Lost In Stratification: The Underutilization Of Fib-4-Guided Masld Screening In The Primary Care Setting, Sanjna Shelukar, Md, Ananya Venkatesh, Md, Breanne Mcdermott, Bs, Julietta Gervase, Ba, Maria Winte, Md, Rebecca Loh, Md, Dina Halegoua-De Marzio, Md

The Medicine Forum

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading contributor to chronic liver disease worldwide. Early identification of MASLD and hepatic fibrosis in the primary care setting is essential for timely and effective management. The Fibrosis-4 (FIB-4) index is recommended as a first-line, non-invasive tool to screen at-risk patients for advanced fibrosis. This study aims to determine FIB-4 screening rates in at-risk patients in an urban resident-led primary care clinic.

A retrospective chart review was conducted in a single Internal Medicine resident-led primary care clinic. Patients aged 36 to 65 years were included, and FIB-4 scores were calculated. Patients were …

A Clinical Assessment: Counseling Families On Timing Of Colorectal Cancer Screening, Bertilia Tavarez, Md, Hamzah Shariff, Md, Breanne Mcdermott, Bs, Sanjna Shelukar, Md, Limi Jamma, Md, Sonali Shah, Md, Akash Patel, Do, Christopher Henry, Md, Aaron Martin, Md

The Medicine Forum

Colorectal cancer (CRC) remains the second most common cause of cancer mortality in the United States. Current recommendations advise initiating colonoscopy at age 40, or 10 years earlier than the youngest affected first-degree relative (FDR), in individuals with a family history of CRC or advanced polyps (AP). Despite these guidelines, their translation into routine clinical counseling is not well defined. This study examines how often patients with CRC or AP receive guidance about early screening for FDRs.

A retrospective review was performed using electronic health records from an urban academic center. Patients diagnosed with CRC or AP between January 2019 …

Commentary On The Withdrawal-Af Trial And Its Applicability In Select Patient Populations, David Zhang, Md

The Medicine Forum

Segan et al. report that 90% of patients with atrial fibrillation- mediated cardiomyopathy (AFCM) maintained left ventricular ejection fraction (LVEF) ≥50% af ter withdrawing heart failure therapy following successful rhythm control.¹ While these results challenge the current practice of indefinite guideline-directed medical therapy (GDMT) in patients with improved ejection fraction, two important questions remain before these findings can be applied more broadly: which patients are appropriate candidates for withdrawal, and how should they be monitored?

The trial excluded patients with coronary disease, structural heart disease, and AF duration exceeding one year. This approach reveals a fundamental challenge, distinguishing pure …

Sudden Syncope Due To Intra Hisian Block With Severely Prolonged His–Ventricular Interval Diagnosed On Electrophysiology Study, Sheraz Qamar, Md, Meiqi Luo, Md

The Medicine Forum

Syncope is a common cause of emergency department evaluation in older adults, when sudden loss of consciousness without prodromal symptoms raises concern for cardiac etiology. We present this case of an 80 year old woman with a prior history of vasovagal syncope who presented after a collapse. Initial evaluation, including electrocardiogram, telemetry, echocardiogram, and ambulatory monitoring, was unrevealing. Given the high risk clinical features such as lack of prodromal symptoms and sudden collapse, an inpatient electrophysiology (EP) study was pursued and demonstrated severe intra Hisian conduction disease with split His bundle electrograms and a markedly prolonged His–ventricular interval. A permanent …

A Strain On The Heart: The Hidden Threat Of Ventricular Tachycardia, Sheraz Qamar, Md, Meiqi Luo, Md, Naila Ijaz, Md, Behzad Pavri, Md, Facc, Praveen Mehrotra, Md, Facc

The Medicine Forum

Mitral valve prolapse (MVP) is increasingly recognized to have an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death independent of mitral regurgitation severity. Mitral annular disjunction (MAD) is a key structural abnormality implicated in abnormal myocardial mechanics and myocardial fibrosis. We describe a patient with MVP and MAD who developed recurrent non-sustained ventricular tachycardia in association with markedly abnormal basal lateral wall longitudinal strain and progressive myocardial fibrosis on cardiac magnetic resonance imaging. Surgical mitral valve repair performed for MAD resulted in resolution of annular disjunction, improvement in regional myocardial strain, and elimination of ventricular arrhythmias. This case …

Lvad Patient With Delayed Family Involvement Due To Incarceration, J. Marco Cipriaso, Md, Kathleen Mechler, Md

The Medicine Forum

Left ventricular assist device (LVAD) placement requires an extensive support system for success. Patients who are incarcerated face unique challenges in achieving this due to prison rules. We describe a case in which an LVAD patient suffered a massive intracranial hemorrhage, leaving him unable to make his own decisions. Medical teams did not involve his family in admissions for his slow chronic decline, but family were asked to make decisions for him at this acute change causing them significant distress. We advocate that families of incarcerated patients be more routinely involved in provider communications and education related to their chronic …

Isolated Left Ventricle Apical Non-Compaction- A Diagnostic Conundrum, Trisha Sindhu, Md, Ranjita Sengupta, Md

The Medicine Forum

Left ventricular non-compaction (LVNC) cardiomyopathy is a rare myocardial disorder characterized by abnormal morphogenesis of the left ventricle (LV). It is typically associated with additional cardiac abnormalities and is most often diagnosed in childhood.¹ We present a unique case of isolated LVNC in a 42-year-old, physically active African American police officer. This case highlights an uncommon presentation of LVNC and underscores the variable specificity of current diagnostic criteria across diverse patient populations.³

A Dose Of Trouble: A Case Of Furosemide Exacerbating Amiodarone-Induced Hypothyroidism, Muneeba Ali, Md, Enad Haddad, Md, Warda Naqvi, Md, Ayesha Afzal, Md, Eddy Mizrahi, Md

The Medicine Forum

Heart failure with reduced ejection fraction is a clinical condition that often requires the concurrent use of multiple medications. Unfortunately, cross reactivity between multiple drugs occurs frequently. Today, we present the case of a 79-year-old male with heart failure and atrial fibrillation on long term amiodarone therapy. His furosemide dose was increased from 40 milligrams (mg) to 80 mg after he developed bilateral lower extremity swelling. The patient eventually developed generalized joint pains, weakness, difficulty maintaining balance, and frequent falls. He reported to the Emergency Department (ED), where he was noted to be suffering from severe acute kidney injury (AKI), …

Ascending Aortic Thrombus With Systemic Embolization: Implications For Risk Stratification And Management, Warda Naqvi, Md, Moses Morgan, Md, Muneeba Ali, Md, Enad Haddad, Md, Zaineb Alhassani, Md

The Medicine Forum

Ascending aortic thrombus is an uncommon clinical finding, particularly in the absence of significant underlying aortic disease, yet it poses a substantial risk for systemic embolization. We describe a 53-year-old woman with a history of cocaine use who presented with acute neurologic deficits and was found to have a left middle cerebral artery occlusion requiring mechanical thrombectomy. Cross-sectional imaging incidentally identified a 1.8 cm thrombus within the ascending aorta. Anticoagulation with intravenous heparin was initiated, however, her clinical course was complicated by recurrent embolic phenomena, including renal infarction and bowel perforation consistent with mesenteric ischemia. Ongoing deterioration with multiorgan failure …

Foreword From Faculty Advisor, Dagan Coppock, Md, Msce

The Medicine Forum

We are honored to present this latest edition of The Medicine Forum. This platform is in its twenty-seventh year serving as an outlet for our medical community’s scholarly and creative efforts. This year, it has been my pleasure to work with Nehar, Jasmine, Hamzah, and Allison on this project. It has been impressive to see them balance their efforts on this scholarly work with their efforts on the wards.

As a Department, we are a productive group of writers, thinkers, scientists, and artists, who send out our work for publication in the larger medical community. What makes The Medicine …

From The Chief Residents, Brian Schonewald, Md, Beatriz Torre, Md, Chukwuemezie Mamanu, Md, Julia Palecki, Md

The Medicine Forum

As the current Chief Residents, we beam with pride at the 27th edition of The Medicine Forum – a culmination of the passion, hard work, and talent of the residents of the Thomas Jefferson Internal Medicine Residency Program. We believe that The Medicine Forum stands as a testament to the fact that our residents are not only outstanding clinicians and medical educators, but also excel across all facets of medicine, including research, quality improvement, and the humanities.

We applaud our talented and driven Chief Editors, Nehar Damle, Hamzah Shariff, Allison Kayne, and Jasmine Lee, who worked diligently to ensure the …

From The Editors, Nehar Damle, Md, Pharmd, Hamzah Shariff, Md, Allison Kayne, Md, Jasmine Lee, Md

The Medicine Forum

As physicians in training, much of our work is shaped by immediacy – responding to evolving clinical situations, navigating diagnostic uncertainty, and making decisions with present information. In this environment, it can be easy to prioritize action over reflection. Yet it is through reflection, inquiry, and shared scholarship that we deepen our understanding of medicine and the patients we serve.

It is within this spirit that we present Volume 27 of The Medicine Forum. This publication represents not only scholarly achievement, but also the intellectual curiosity and dedication that define our community.

This year, we were particularly struck by …

From The Desk Of The Residency Program Director, Christopher Henry, Md. Facp

The Medicine Forum

I am excited to once again share this year’s The Medicine Forum. It continues to open a window into the tireless commitment our residents bring to the bedside and to the field of medicine at large. As is uniquely our brand at Jefferson, the residents accomplish this with as much rigorous intellect as with their abundant enthusiasm and personality.

In an era where artificial intelligence has become an ever-burgeoning tool in the clinical landscape, the ingenuity displayed by our residents both in their artistic talents and their scholarly pursuits serves as a vital reminder. It reminds me that the …

Table Of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum: Volume 27

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 27, 2025-2026

TABLE OF CONTENTS

• Case Reports
• Letter to the Editor
• Research Studies
• Humanities & Reflections

Myelomalacia Severity On Preoperative Magnetic Resonance Imaging Does Not Predict Patient-Reported Outcomes After Anterior Cervical Discectomy And Fusion, Mitchell K. Ng, Joshua Mathew, Robert J. Oris, Yulia Lee, Jonathan Dalton, Gregorio Baek, Ashley Thommana, William A. Green, Yasmine Eichbaum, Morgan Hitchner, Brandon Martinazzi, Ali Farooqi, Alec Giakas, Paul Gunter, Vinay Bijoor, Andrew Vanchikorn, John J. Mangan, David I. Kaye, Mark F. Kurd, Thomas Cha, Jose A Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN/SETTING: Retrospective cohort study.

BACKGROUND: Signal changes within the spinal cord on magnetic resonance imaging (MRI) or myelomalacia, are frequently seen in patients with cervical myelopathy. While often assumed to predict the outcomes, their prognostic value remains uncertain. Therefore, this study aimed to: (1) describe the clinical characteristics of patients with myelomalacia undergoing Anterior cervical discectomy and fusion (ACDF); (2) evaluate whether MRI findings correlate with patient-reported outcomes (PROMs); and (3) determine whether morphology predict recovery.

METHODS: A retrospective review at a single tertiary care center was performed (2014-2021). Patients were included if they underwent a primary elective ACDF …

Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope And Limitations, Kai-Uwe Lewandrowski, Álvaro Dowling, Jun Ho Lee, Benedikt W Burkhardt, Óscar L. Alves, Avelino Parajón, Jorge Felippe Ramirez, Nicola Montemurro, Alex R. Vaccaro, Morgan P. Lorio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity.

OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence.

METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied …

Insurance Type And Menopausal Hormone Therapy Use Among Us Women, Arina Chesnokova, Sunni Mumford, Allison Schachter, Rebecca Hamm, Scott Lorch, Matthew Klebanoff, Sarah Lindley, Erika Harness, Makeba Williams, Marilyn Schapira

Student Papers, Posters & Projects

IMPORTANCE: Access to menopausal hormone therapy (MHT) in the US remains low. Understanding whether insurance type is associated with MHT underuse and racial disparities in menopausal care is critical for designing interventions that increase evidence-based and equitable menopause care.

OBJECTIVE: To examine whether Medicaid compared with private insurance is associated with lower MHT use among US women. A secondary objective explored the degree that payer type is associated with observed racial differences in MHT use.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2013-2014, 2015-2016, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify …

Immediate Postoperative Pacing Dependency Is Not Associated With Worse Mid-Term Survival In Redo Mitral Valve Surgery, Devon Kelley, Joyce Ho, Andrew Belec, Takahiro Tashima, Victoria Li, James Lao, Varun Kathawate, Kazuhiro Ueno, Amit Iyengar, Jessica Dominic, Pavan Atluri

Division of Cardiology Faculty Papers

Risk factors (RF) for permanent pacemaker (PPM) placement in cardiac surgery include valvular operations and redo operations. We aim to identify RF for PPM placement prior to discharge (DC) specifically among redo mitral valvular operations, and to analyze outcomes in this population. Our retrospective review considered 943 patients undergoing redo MV operations between 01/2002 and 12/2021, excluding patients experiencing in-hospital death within 48 hours of their operation and patients with existing PPM or implanted cardiac defibrillator (ICD). Patients (n = 742) were categorized based on whether they received a PPM before DC or not. Of the 742 patients analyzed, 47 …

Cerebrovascular Risk With Calcitonin Gene-Related Peptide Monoclonal Antibodies Versus Onabotulinumtoxina In Patients With Migraine: A Real-World Pharmacoepidemiologic Study In The National Institutes Of Health All Of Us Research Program, Sedat Gül, Bradley Ong, Stephen Trudeau, Nicolas Thompson, Hsiangkuo Yuan

Department of Jefferson Headache Center Papers and Presentations

AimTo evaluate whether initiation of calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) was non-inferior to initiation of onabotulinumtoxinA with respect to the hazard of ischemic stroke or transient ischemic attack (IS + TIA) in a real-world cohort of adults with migraine.MethodsWe conducted a retrospective, active-comparator, new-user pharmacoepidemiology study using the NIH All of Us Research Program Registered Tier Dataset (v8). Adults with migraine initiating CGRP mAbs (erenumab, fremanezumab, galcanezumab, eptinezumab) were compared with initiators of onabotulinumtoxinA from January 2018 through September 2023. The primary outcome was IS + TIA occurring more than 90 days after treatment initiation. Inverse probability of …

Long-Term Outcomes And Symptom Response Following Hypofractionated Stereotactic Radiotherapy For Intracranial Meningioma, Ryan Shah, Bs, Nilanjan Haldar, Shray Jain, Lauren Holt, Sophia Shah, Hamail Iqbal, Anthony Chen, Christopher J. Farrell, Debanjan Haldar, James J. Evans, Gregory S. Alexander, Wenyin Shi

Department of Neurology Faculty Papers

Objective: Various radiation dosing regimens exist due to tumor size, location, and patient preference. This study evaluated the long-term outcomes of patients with benign meningiomas treated with hypofractionated stereotactic radiotherapy (SRT)at our institution.

Methods: This is a retrospective review of all patients diagnosed with meningioma at our institution who received hypofractionated SRT (5 fractions). Clinical data, including tumor location, size, prior treatments, demographics, radiation dosimetric information, tumor response, and survival were collected. Kaplan-Meier curves were used to assess local control (LC). Acute and late toxicities were evaluated. Patients were included for analysis if they had at least one post-treatment magnetic …

Outcomes With Cerclage For Short Cervix ≤20.9 Mm Before 24 Weeks In Singletons Without Prior Preterm Birth: A Focused Meta-Analysis Of Randomized Controlled Trials, Rupsa Boelig, Kypros Nicolaides, Orion Rust, Katsufumi Otzuki, Sietske Althuisius, Gabriele Saccone, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Cefepime Pharmacokinetics In Critically Ill Children With Multiple Organ Dysfunction Syndrome Using Volumetric Absorptive Microsampling, Victor Amajor, Amanda Bwint, Steven Shein, Janet Hume, Courtney Rowan, Leeanne Flygt, Matthew Malone, Erin Stenson, Scott Weiss, Matt Zinter, Sujatha Kannan, Mary Dahmer, Ryan Nofziger, Manjunath Pai, Athena Zuppa, Nathaniel Rhodes, Mark Hall, Marc Scheetz, Kevin Downes

Department of Pediatrics Faculty Papers

Up to half of critically ill children experience multiple organ dysfunction syndrome (MODS), which worsens outcomes and increases mortality risk. Cefepime is a broad-spectrum antibiotic commonly used in pediatric sepsis, but its pharmacokinetics during MODS has not been evaluated. We performed a prospective, observational study of critically ill children with MODS who were administered cefepime and collected up to 15 whole blood samples over 3 days using volumetric absorptive microsampling (VAMS). We performed nonlinear mixed-effects modeling to develop a population PK model for cefepime in children with MODS. We then reran our final population PK model using estimated plasma concentrations …

Risk Of Fracture Following Androgen Receptor Pathway Inhibitors In Men With Advanced Prostate Cancer, Grace Lu-Yao, Nikita Nikita, Scott W. Keith, Krupa Gandhi, Amy L. Shaver, Swapnil Sharma, Christina Steinbock-Malfer, Hushan Yang, Christopher Yang, Kevin K. Zarrabi, Stephen J. Freedland, William K. Kelly

Kimmel Cancer Center Faculty Papers

BACKGROUND: This population-based study aimed to quantify fracture risk after androgen receptor pathway inhibitors in advanced prostate cancer patients by preexisting health conditions.

METHODS: Patients were identified from the Surveillance, Epidemiology, and End Results-Medicare files who received abiraterone acetate with prednisone or enzalutamide between January 1, 2013, and December 31, 2020. Health and fracture history were based on claims 1 year before androgen receptor pathway inhibitor with follow-up through December 31, 2020. The main outcome of the study was the cumulative fracture risk after first date of androgen receptor pathway inhibitor. Fine and Gray subdistribution hazard model was used to …

Subcutaneous Nodules On The Elbows Of A Teenager, Arman Haveric, Jayci G. Rhein, Jason B. Lee, Shayan Waseh, Sylvia Hsu, Afton R. Metkowski

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

A Phase-Ii Randomized Controlled Pilot Study Of Nicotinamide Riboside Supplementation In Older Adults With Amnestic Mild Cognitive Impairment, Christopher Martens, Kevin Decker, Theodore Deconne, Faria Sanjana, Fiona Horvat, Nicholas Rizzi, Catherine Awad, Elizabeth Habash, Joshua Hobson, Mary Kramer, Michael Armstrong, Nichole Reisdorph, Ryan Pohlig, Alyssa Lanzi, Curtis Johnson, Matthew Cohen, James Ellison

Department of Psychiatry and Human Behavior Faculty Papers

INTRODUCTION: Declining nicotinamide adenine dinucleotide (NAD+) may elevate risk of Alzheimer's disease.

METHODS: We conducted a 12-week double-blind, randomized, placebo-controlled pilot study to evaluate the safety, tolerability, and preliminary efficacy of the NAD+ precursor, nicotinamide riboside (NR), for enhancing cognitive function and cerebral blood flow (CBF) in adults with amnestic mild cognitive impairment (aMCI).

RESULTS: 42 participants completed the study (NR = 22, placebo = 20). Adherence was similar between groups with no serious adverse effects. Blood NAD+ increased twofold in the NR group. There were no improvements in cognitive function (primary outcome), total CBF, or blood pressure (secondary outcomes). …

Donor-Derived Cell-Free Dna As A Prognostic Biomarker After Heart Transplantation: The Define-Ht Study, Palak Shah, Paul J. Kim, Kelly H. Schlendorf, David A. Baran, Monica M. Colvin, Adam D. Devore, Howard Eisen, Kambiz Ghafourian, Michael M. Givertz, Eileen Hsich, Jaime L. W. Kennedy, Evan P. Kransdorf, Jose N. Nativi-Nicolau, Jignesh Patel, Eleni Tseliou, Omar Wever-Pinzon, Andrew Doud, Michelle S. Bloom, Sandra A. Carey, Navchetan Kaur, D Giovanni Biagini, Kyle E. Marshall, Michael Olympios, Mandeep R. Mehra, Josef Stehlik

Department of Medicine Faculty Papers

BACKGROUND: Measurement of donor-derived cell-free DNA fraction (dd-cfDNA%) and donor quantity score (DQS) is a noninvasive biomarker of acute rejection in heart transplantation (HT). Its prognostic value beyond histopathology remains uncertain.

OBJECTIVES: This study sought to evaluate associations between donor-derived cell-free DNA (dd-cfDNA) and clinically meaningful outcomes using a composite endpoint of treated rejection, graft dysfunction, retransplantation, or death within 1 year post-HT.

METHODS: The DEFINE-HT (Development of Noninvasive Cell-free DNA to Supplant Invasive Biopsy in Heart Transplantation) was a prospective, observational study following adult HT recipients at 10 U.S. centers for 1-year post-HT; blood was collected for dd-cfDNA testing …

Fluoroquinolone Use And Risk Of Pneumothorax In Adults Hospitalized With Community Acquired Pneumonia: A Retrospective Cohort Study, Steven Yi B. S., Saurav Sumughan B.S., Jessica Cobb M. D., Erika J. Yoo

Department of Medicine Faculty Papers

Objectives: The objective of this study is to examine the relationship between fluoroquinolone exposure and pneumothorax risk in patients hospitalized with pneumonia.

Methods: This retrospective cohort study used the TriNetX US Collaborative Network. We defined two mutually exclusive cohorts of hospitalized adults based on exposure to antibiotic classes commonly used to treat community acquired pneumonia: fluoroquinolone (ciprofloxacin, moxifloxacin, levofloxacin, and ofloxacin) versus nonfluoroquinolone (amoxicillin, azithromycin, ceftriaxone, and doxycycline). Patients with connective tissue disorders were excluded. The primary outcome was the occurrence of pneumothorax within 60 days. We used Cox proportional hazards regression to estimate hazard ratios (HRs) adjusted for demographics, …

Neoadjuvant Immunotherapy For Hepatocellular Carcinoma Is Associated With Improved Survival After Hepatectomy: A Matched Analysis Of The 2017 To 2022 National Cancer Database, Lawrence Chiang, Adam Bodzin, Daniel Lin, Nader Hanna, Scott Koeneman, Hien Dang, Charles J. Yeo, Christopher Shubert, R. Zheng

Department of Surgery Faculty Papers

Background: Effects of neoadjuvant immunotherapy (NIT) before liver resection are not well-described in hepatocellular carcinoma (HCC). Survival and R0 resection rates in HCC patients undergoing curative-intent resection with or without NIT were evaluated.

Methods: A retrospective study of stage I-III HCC patients undergoing hepatectomy from the 2017–2022 National Cancer Database was performed. Patients receiving NIT were exactly matched 1:3 to non-NIT patients by clinical stage. Primary outcomes were margin positivity, 30- and 90-day mortality, and overall survival.

Results: After matching 510 patients, 97 received NIT and 291 did not (non-NIT). Resections included segmental (178, 45.9%), lobar (149, 38.4%), and extended …

In Vivo Evidence Of Blood Flow Slippage: Failure Of The No-Slip Boundary Condition Assumption, Alena Jarolímová, Jaroslav Hron, Karel Tůma, Radomír Chabiniok, Josef Málek, Keshava Rajagopal

Division of Cardiology Faculty Papers

The assumption that blood adheres to vessel walls with zero tangential velocity component, the so-called "no-slip" boundary condition, is a foundational premise of cardiovascular fluid dynamics. Whether the no-slip condition holds in vivo, however, remains unknown. Seven healthy adult volunteers underwent cardiovascular magnetic resonance imaging. With four-dimensional flow magnetic resonance imaging of the descending thoracic aorta and modeling blood as a Navier-Stokes fluid, near-wall blood velocities were quantified, and wall shear stress was calculated based on the measured velocity fields. Within the Navier-Stokes data assimilation framework, tangential wall velocities of ∼30-80% of the mean luminal velocity were consistently obtained. These …