Cardiology Commons^™

Cardiac Remodeling And Dysfunction In Childhood Obesity: A Cardiovascular Magnetic Resonance Study, Linyuan Jing, Cassi M. Binkley, Jonathan D. Suever, Nivedita Umasankar, Christopher M. Haggerty, Jennifer Rich, Christopher D. Nevius, Gregory J. Wehner, Sean M. Hamlet, David K. Powell, Aurelia Radulescu, H. Lester Kirchner, Frederick H. Epstein, Brandon K. Fornwalt

Pediatrics Faculty Publications

Background: Obesity affects nearly one in five children and is associated with increased risk of premature death. Obesity-related heart disease contributes to premature death. We aimed to use cardiovascular magnetic resonance (CMR) to comprehensively characterize the changes in cardiac geometry and function in obese children.

Methods and results: Forty-one obese/overweight (age 12 ± 3 years, 56 % female) and 29 healthy weight children (age 14 ± 3 years, 41 % female) underwent CMR, including both standard cine imaging and displacement encoded imaging, for a complete assessment of left ventricular (LV) structure and function. After adjusting for age, LV mass index …

The Effect Of Heart Failure Education On Knowledge And Readmission, Sara A. Golden

Evidence-Based Practice Project Reports

Heart Failure (HF) is a chronic progressive disease affecting over 5 million individuals with an expected increase in incidence as the population ages (Yehle & Plake, 2010). The costs associated with managing HF continue to increase and the Centers for Medicare and Medicaid Services (CMS) have attempted to identify ways to improve patient management of HF to reduce the revolving door of hospital readmissions and decrease expenditures. According to 2006 data, as many as one fourth of the Medicare beneficiaries discharged from acute care to skilled nursing facilities (SNF) were readmitted to the hospital within 30 days and the majority …

Routine Screening For Abdominal Aortic Aneurysm: Is It For Everyone?, Catherine E. Nowak

Physician Assistant Capstones, 2016 to 2019

Objective: Determine whether routine abdominal ultrasound screening in all men ages 65 and over, not just those who are symptomatic or at risk, would be beneficial in reducing the mortality rate from abdominal aortic aneurysms (AAA). Design: Systematic literature review. Methods: The clinical question investigated is whether routine ultrasound screening of AAA for men over age 65 reduces AAA-related mortality as compared to not routinely screening. Searches were done through PubMed using the keywords: screening, abdominal aortic aneurysm, reduce, and mortality. Citations used by the USPSTF AAA screening guidelines were also added to the literature search. In PubMed, further limitations …

Programming Heart Disease: Does Poor Maternal Nutrition Alter Expression Of Cardiac Markers Of Proliferation, Hypertrophy, And Fibrosis In Offspring?, Cathy Chun

Honors Scholar Theses

Maternal malnutrition can affect fetal organogenesis, metabolic processes, and factors involved in developmental regulation. Of the many physiological effects poor maternal nutrition can induce in offspring, one of the most important organs affected is the heart. Cardiovascular disease has been associated with poor maternal diet. It also been suggested that hypertension can originate during impaired intrauterine growth and development. Hypertension can trigger hypertensive heart disease and is associated with numerous heart complications. We hypothesized that poor maternal nutrition would alter critical growth factors associated with normal heart development, specifically, insulin-like growth factor (IGF)-1, IGF-2, transforming growth factor (TGF)β, and connective …

Association Of Self-Care Confidence And Hospital Readmission Following Student Nurse Led Congestive Heart Failure Transitional Care Project, Peyton A. Phelps

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Over 5 million Americans have been diagnosed with heart failure, and that number is growing. This disease is burdensome to the patient as it lessens their quality of life and to the healthcare system due to costliness and frequent readmissions. This study aims to evaluate if a student nurse led transitional care program can increase patient self-care confidence, in turn reducing 30 day hospital readmission rates. Twenty patients completed the Self Care of Heart Failure Index before and after a 14-week transitional care program. These reported data were compared using a paired samples t-test. There was not a …

Biventricular Myocardial Performance Is Impaired In Proportion To Severity Of Obstructive Sleep Apnea, Selahattin Akyol, Mustafa Cortuk, Ahmet Oytun Baykan, Kemal Kiraz, Abdurrezzak Borekci, Taner Seker, Mustafa Gur, Murat Cayli

The Texas Heart Institute Journal

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and death. Little information is available regarding the relationship between the severity of OSA and myocardial performance in OSA patients who have normal ejection fractions. We prospectively investigated this relationship, using the tissue-Doppler myocardial performance index (TD-MPI).

We conducted overnight, full-laboratory polysomnographic examinations of 116 patients, and calculated the left and right ventricular TD-MPIs. Patients were classified into 3 groups in accordance with their apnea-hypopnea index (AHI) levels: AHImild (≥5 to <15), AHImoderate (≥15 to <30), and AHIsevere (≥30).

Left and right ventricular TD-MPI values were higher in the AHIsevere group than in the AHImild and …

Advancing A Guiding Catheter Across A Mechanical Aortic Valve, Wassim Shatila, Guilherme V Silva

The Texas Heart Institute Journal

No abstract provided.

Cardiac Papillary Fibroelastoma: Single-Institution Experience With 14 Surgical Patients, Walid K Abu Saleh, Odeaa Al Jabbari, Basel Ramlawi, Michael J Reardon

The Texas Heart Institute Journal

In general, treatment for symptomatic and asymptomatic cardiac papillary fibroelastoma is surgical resection-particularly of left-sided lesions, because of the risk of systemic embolization. However, few institutions have enough experience with these tumors to validate this approach. We present our institutional experience with papillary fibroelastoma and discuss our current approach. We searched our institution's cardiac tumor database, identified all patients diagnosed with cardiac papillary fibroelastoma from 1992 through 2014, and recorded the clinical and pathologic characteristics of each case. We found 14 patients (mean age, 60.5 ± 12.3 yr) who had 18 lesions. Eleven patients (79%) were symptomatic; however, we could …

Bioprosthetic Aortic Valve Endocarditis In Association With Enterococcus Durans, Luca Fallavollita, Lorena Di Gioacchino, Fabrizio Balestrini

The Texas Heart Institute Journal

Enterococci are common organisms associated with endocarditis, but infection by Enterococcus durans is very rare. To our knowledge, only 3 cases have been reported in the medical literature, and all 3 have involved native valves. Here we publish the first reported case (to our knowledge) of E. durans endocarditis in association with a bioprosthetic aortic valve. After the organism and its antibiotic susceptibility were identified, the 74-year-old male patient was treated successfully with teicoplanin and gentamicin, over a course of 6 weeks.

Longitudinal Changes In Vascular Risk Markers And Mortality Rates Among A Latino Population With Hypertension, Matthew C Pflederer, Carlin S Long, Brenda Beaty, Edward P Havranek, Philip S Mehler, Angela Keniston, Mori J Krantz

The Texas Heart Institute Journal

Vascular markers such as pulse-wave velocity and carotid intima-media thickness (CIMT) might improve the prediction of incident cardiovascular disease beyond traditional risk factors. These vascular markers have not been well characterized in minority populations and might be more useful than inflammatory biomarkers. We conducted a prospective, longitudinal cohort study among hypertensive patients in an urban safety-net hospital. We evaluated inflammatory biomarkers, arterial pulse-wave velocity, and carotid intima-media thickness at baseline, 1 year, and 2 years. The primary outcome variable was CIMT. Generalized linear mixed-effects models were used to evaluate associations between CIMT and predictive variables accounting for the correlation of …

'Refractory Epilepsy': What Lies Beneath?, Syedah Saira Bokhari, Satwat Hashmi

Section of Internal Medicine

A 30-year-old woman presented to the emergency room with recurrent seizures for 5 days. She had been diagnosed with epilepsy 2 years previously but stopped treatment due to the side effects of her medications. She was now experiencing episodes every 15-30 min. While undergoing a brain MRI to investigate for structural central nervous system pathology, she experienced another episode, preceded by prodromal symptoms. Polymorphic ventricular tachycardia was noted during the event. Further investigation revealed a normal QT interval, normal electrolyte panel, normal coronaries and severe left ventricular systolic dysfunction. Cardiac MRI revealed non-ischaemic cardiomyopathy. The patient was managed with heart …

A Dataset To Assess Providers׳ Knowledge And Attitudes Towards The 2013 American College Of Cardiology/American Heart Association Cholesterol Management Guideline, Yashashwi Pokharel, Lynne Steinberg, Winston Chan, Julia M. Akeroyd, Peter H. Jones, Vijay Nambi, Khurram Nasir, Laura Petersen, Christie M. Ballantyne, Salim S. Virani

Office of the Provost

We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives.

Higher Risk For Incident Heart Failure And Cardiovascular Mortality Among Community-Dwelling Octogenarians Without Pneumococcal Vaccination, Momanna Ahmed, Kanan Patel, Gregg C. Fonarow, Charity J. Morgan, Javed Butler, Vera Bittner, Andrzej Kulczycki, Raya Kheirbek, Wilbert S. Aronow, Ross D. Fletcher, Cynthia J. Brown, Ali Ahmed

NYMC Faculty Publications

AIMS: Octogenarians have the highest incidence of heart failure (HF) that is not fully explained by traditional risk factors. We explored whether lack of pneumococcal vaccination is associated with higher risk of incident HF among octogenarians.

METHODS AND RESULTS: In the Cardiovascular Health Study (CHS), 5290 community-dwelling adults, ≥65 years of age, were free of baseline HF and had data on pneumococcal vaccination. Of these, 851 were octogenarians, of whom, 593 did not receive pneumococcal vaccination. Multivariable-adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for associations of lack of pneumococcal vaccination with incident HF and other outcomes during 13 …

Optimizing Electrocardiogram Interpretation And Catheterization Laboratory Activation In St-Segment Elevation Myocardial Infarct, Alexander E. Sullivan, Mortada Shams, Marco A. Mercader, Jacob Varghese, Abudureyimu Shajidan, Bassel Hassouna, Vimala V. Jayanthi

GW Research Days 2016 - 2020

Background: To achieve the 90-minute reperfusion goal in ST-segment elevation myocardial infarction (STEMI) care, providers must diagnose STEMIs from electrocardiograms (ECGs) obtained upon emergency room arrival and appropriately activate the catheterization lab. To enhance early STEMI care, we sought to improve medical student STEMI recognition and diagnostic accuracy with a teaching module we designed and developed.

Methods: Through a literature review, we identified evidenced-based criteria for classic STEMI patterns, STEMI-equivalents with non-classic STEMI patterns including hyperacute T-waves, STEMI with existing left bundle branch block (LBBB) and Wellens’ syndrome and non-ischemic STEMI-mimics such as known LBBB, pericarditis, ventricular aneurysm, …

Effectiveness Of Pharmacist-Led Amiodarone Monitoring Services On Improving Adherence To Amiodarone Monitoring Recommendations: A Systematic Review, Dave L. Dixon, Steven P. Dunn, Michael S. Kelly, Timothy R. Mcllarky, Roy E. Brown

Pharmacy Faculty Articles and Research

Amiodarone remains the mostly frequently used antiarrhythmic in clinical practice and is most often used to maintain normal sinus rhythm in patients with atrial fibrillation who have failed a rate control strategy. Amiodarone has superior efficacy over other antiarrhythmics, a lower risk of torsade de pointes, and a better cardiovascular safety profile in patients with structural heart disease. However, amiodarone is associated with notable noncardiac toxicities affecting the thyroid, lungs, eyes, liver, and central nervous system. Since 2000, clinicians have been advised to follow amiodarone monitoring guidelines provided by the Heart Rhythm Society. Adherence to these recommendations in clinical practice, …

Durability Of The Starr-Edwards Heart Valve: Early Decisions Led To Successful Results, Albert Starr, Gary L Grunkemeier

The Texas Heart Institute Journal

No abstract provided.

Cutting The Cost Of Health Care: The Physician's Role, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Alternative Surgical Approach To Repairing A Giant Sinus Of Valsalva Aneurysm, Vincenzo Giambruno, Cristina Cucchietti, Calogera Pisano, Jonathan Hyde

The Texas Heart Institute Journal

We report our method of surgically repairing an unruptured giant aneurysm of the right coronary sinus of Valsalva, a lesion that caused moderate aortic regurgitation but no symptoms in a 61-year-old woman. We excised the aneurysm, reconstructed the right sinus of Valsalva with use of a patch, performed mechanical aortic valve replacement directly through the excised aneurysm's cavity, and constructed a single bypass graft to the right coronary artery. The patient was discharged from the hospital after 5 days. Twelve months postoperatively, her clinical and echocardiographic results were normal, and she was doing well. To our knowledge, our surgical approach …

Aortic Dissection Caused By Percutaneous Coronary Intervention: 2 New Case Reports And Detailed Analysis Of 86 Previous Cases, Priyank Shah, Sharad Bajaj, Fayez Shamoon

The Texas Heart Institute Journal

Aortic dissection, a rare sequela of percutaneous coronary intervention, can be fatal when it is not recognized and treated promptly. Treatment varies from conservative management to invasive aortic repair and revascularization. We report the cases of 2 patients whose aortic dissection was caused by percutaneous coronary intervention. In addition, we present detailed analyses of 86 previously reported cases. Aortic dissection was most often seen during intervention to the right coronary artery (in 76.7% of instances). The 2 most frequently reported causes were catheter trauma (in 54% of cases) and balloon inflation (in 23.8%). The overall mortality rate was 7.1%. We …

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical And Hemodynamic Follow-Up, Michele Celiento, Stefania Blasi, Andrea De Martino, Stefano Pratali, Aldo D Milano, Uberto Bortolotti

The Texas Heart Institute Journal

We reviewed the cases of 100 patients (mean age, 73 ± 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 ± 0.7, and 52 patients were in atrial fibrillation. Prosthetic sizes were chiefly 27 mm (50 patients) and 29 mm (40 patients). Follow-up ended in December 2012 and is 97% complete, with a cumulative duration of 611 patient-years (mean duration, 6 ± 4.6 yr; maximum, 17.7 yr). The early mortality rate was 10% (6% in elective patients); late deaths occurred …

Development And Validation Of A Preprocedural Risk Score To Predict Access Site Complications After Peripheral Vascular Interventions Based On The Vascular Quality Initiative Database, Daniel Ortiz, Maharaj Singh, Arshad Jahangir, Suhail Allaqaband, Anjan Gupta, Tanvir Bajwa, Mark W. Mewissen

Journal of Patient-Centered Research and Reviews

Purpose

Access site complications following peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI.

Methods

The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression …

Coronary Flow Reserve In Adults With Systemic Right Or Single Ventricles, Laura J. Olivieri, Li-Yueh Hsu, Anitha S. John, Karen S. Kuehl, Andrew Arai

Pediatrics Posters and Presentations

No abstract provided.

Development And Application Of Gadolinium Free Cardiac Magnetic Resonance Fibrosis Imaging For Multiscale Study Of Heart Failure In Patients With End Stage Renal Disease, Tori A. Stromp

Theses and Dissertations--Physiology

Cardiac magnetic resonance (CMR) is a powerful tool to noninvasively image ventricular fibrosis. Late gadolinium enhancement (LGE) CMR identifies focal and, with T1 mapping, diffuse fibrosis. Despite prevalent cardiac fibrosis and heart failure, patients with end stage renal disease (ESRD) are excluded from LGE. Absence of a suitable diagnostic has limited the understanding of heart failure and obstructed development of therapies in the setting of ESRD. A quantitative, gadolinium free fibrosis detection method could overcome this critical barrier, propelling the advancement of diagnostic, monitoring, and therapy options. This project describes the development of a gadolinium free CMR technique and application …

Overweight Predicts Poorer Exercise Capacity In Congenital Heart Disease Patients, Karen Kuehl, Alicia Tucker, Munziba Khan, Paula Goldberg, E. Anne Greene, Megan Smith

Pediatrics Faculty Publications

Background

Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults.

Methods

Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85–95 or > 95 percentile respectively for age and gender …

Endometrial Stromal Sarcoma Metastatic From The Uterus To The Inferior Vena Cava And Right Atrium, Daniel Scher, William Nghiem, Salim Aziz, Rodeen Rahbar, Whitney Banks, Anthony Venbrux, Shawn Sarin

The Texas Heart Institute Journal

Endometrial stromal sarcoma metastases usually occur within the pelvis and rarely involve the great vessels or the heart. We present the case of a 55-year-old woman who was referred for endovascular therapy to treat presumed thrombosis of the inferior vena cava. The suspected thrombus was recalcitrant to endovascular removal with use of an AngioVac venous drainage device. Results of an intraprocedural transvenous biopsy revealed the mass to be the intravascular extension of an endometrial stromal sarcoma. The patient underwent surgical excision of the tumor, and, shortly thereafter, a hysterectomy and salpingo-oophorectomy. This complex case highlights both the rarity of malignancy …

Tunneling A Pulmonary Artery Graft: A Simplified Way To Insert And Remove A Temporary Right Ventricular Assist Device, Pankaj Saxena, Silvana F Marasco

The Texas Heart Institute Journal

Right ventricular failure can occur early or late after left ventricular assist device implantation. Support with a right ventricular assist device is needed in patients whose right ventricular failure does not respond to conservative management. The use of a temporary right ventricular assist device can enable the recovery of right ventricular function and avoid the use of a more permanent biventricular assist device, which is associated with complications and higher costs. We present our technique of instituting temporary right ventricular assist device support in patients who have undergone left ventricular assist device implantation.

Multivariate Criteria Most Accurately Distinguish Cardiac From Noncardiac Causes Of Dyspnea, Mirza Nubair Ahmad, Syed Hasan Yusuf, Rafath Ullah, Mirza Mujadil Ahmad, Mary K Ellis, Haroon Yousaf, Timothy E Paterick, Khawaja Afzal Ammar

The Texas Heart Institute Journal

Cardiopulmonary exercise testing provides oxygen pulse as a continuous measure of stroke volume, which is superior to other stress-testing methods in which systolic function is measured at baseline and at peak stress. However, the optimal peak oxygen pulse criterion for distinguishing cardiac from noncardiac causes of exercise limitation is unknown.

In comparing several peak oxygen pulse criteria against the clinical standard of cardiopulmonary exercise testing, we retrospectively studied 54 consecutive patients referred for cardiopulmonary exercise testing. These exercise tests included measurement of oxygen consumption, carbon dioxide production, breathing reserve, arterial blood gases at baseline and at peak stress, exercise electrocardiogram, …

Banning The Handshake From Healthcare Settings Is Not The Solution To Poor Hand Hygiene, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Microaxial Flow Left Ventricular Assist Device As A Bridge To Transplantation After Lvad Malfunction, Heidi J Reich, Aamir Shah, Babak Azarbal, Jon Kobashigawa, Jaime Moriguchi, Lawrence Czer, Fardad Esmailian

The Texas Heart Institute Journal

Evolving technology and improvements in the design of modern, continuous-flow left ventricular assist devices have substantially reduced the rate of device malfunction. As the number of implanted devices increases and as survival prospects for patients with a device continue to improve, device malfunction is an increasingly common clinical challenge. Here, we present our initial experience with an endovascular microaxial flow left ventricular assist device as a successful bridge to transplantation in a 54-year-old man who experienced left ventricular assist device malfunction.

Score Big For Decreasing Mortality: Icd Risk Score Model, Linda Francaviglia, Rachel Petersen, Maria Stone, M. Eyman Mortada

Journal of Patient-Centered Research and Reviews

Background: Aurora Health Care, a system of 14 acute care hospitals in eastern Wisconsin, has been a long-time participant in the American College of Cardiology’s National Cardiovascular Data Registries, submitting data to its ICD Registry™ since 2005. Our system’s implantable cardioverter-defibrillator (ICD) procedure volume averages 930 cases annually. During 2012 we experienced an increase in in-hospital mortality/morbidity for ICD cases.

Purpose: A single-center study examining in-hospital mortality/morbidity post-ICD implant before and after changes in practice and patient selection.

Methods: ICD implants and generator changes discharged from January 1, 2009, to December 31, 2012, were included in developing a risk model …