Cardiology Commons^™

Outcomes Of Open Mitral Valve Replacement Versus Transcatheter Mitral Valve Repair; Insight From The National Inpatient Sample Database., Waqas Ullah, Yasar Sattar, Maryam Mukhtar, Hafez M. Abdullah, Vincent M. Figueredo, Donald C. Haas, David L. Fischman, M. Chadi Alraies

Abington Jefferson Health Papers

Background: Transcatheter mitral valve repair and replacement (TMVR) is a minimally invasive alternative to conventional open-heart mitral valve replacement (OMVR). The present study aims to compare the burden, demographics, cost, and complications of TMVR and OMVR.

Methods: The United States National Inpatient Sample (US-NIS) for the year 2017 was queried to identify all cases of TMVR and OMVR. Categorical and continuous data were analyzed using Pearson chi-square and independent t-test analysis, respectively. An adjusted odds ratio (aOR) based on the ordinal logistic regression (OLR) model was calculated to determine the association between outcome variables.

Results: Of 19,580 patients, 18,460 …

A Rare Case Of Coronary Artery Thrombosis In A Patient With Recently Diagnosed Giant Cell Arteritis: Is Anticardiolipin Antibody Involved?, Khine S. Shan, Qian Zhang, Sharmila Bisaria, Anubha Tewary

Abington Jefferson Health Papers

Giant cell arteritis (GCA) is an immune-mediated systemic inflammation of large-sized arteries that predominantly affects elderly women. It may be considered as one of the risk factors for acute coronary syndrome (ACS). Moreover, patients with GCA may have increased anticardiolipin antibodies (aCL). However, its relationship with antiphospholipid syndrome (APS) is not clear. We present a case of a unique presentation of GCA with a connection to both ACS and APS. A 76-year-old woman who initially presented to the hospital with a chief complaint of intermittent unilateral headache, blurry vision along with transient aphasia was found to have a biopsy confirmed …

Cardiac Interventions In Patients With Achondroplasia: A Systematic Review., Amrita Sukhavasi, Thomas J O'Malley, Elizabeth J Maynes, Jae Hwan Choi, Jonathan S Gordon, Kevin Phan, Vakhtang Tchantchaleishvili

Jefferson Hospital Staff Papers and Presentations

Patients with achondroplasia and other causes of dwarfism suffer from increased rates of cardiovascular disease relative to the remainder of the population. Few studies have examined these patients when undergoing cardiac surgery or percutaneous intervention. This systematic review examines the literature to determine outcomes following cardiac intervention in this unique population. An electronic search was performed in the English literature to identify all reports of achondroplasia, dwarfism, and cardiac intervention. Of the 5,274 articles identified, 14 articles with 14 cases met inclusion criteria. Patient-level data was extracted and analyzed. Median patient age was 55.5 [interquartile ranges (IQR), 43.8, 59.8] years, …

Reversing Heart Failure With A Ventricular Anchoring Device: Another Hope For Myopathic Mitral Regurgitation., J. Eduardo Rame

Center for Translational Medicine Faculty Papers

No abstract provided.

Implications Of C1q/Tnf-Related Protein Superfamily In Patients With Coronary Artery Disease., Yanwei Zhang, Caihong Liu, Jing Liu, Rui Guo, Zheyi Yan, Wenxia Liu, Wayne Bond Lau, Xiangying Jiao, Jimin Cao, Kun Xu, Yongping Jia, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

The C1q complement/TNF-related protein superfamily (CTRPs) displays differential effects on the regulation of metabolic homeostasis, governing cardiovascular function. However, whether and how they may serve as predictor/pro-diagnosis factors for assessing the risks of coronary artery disease (CAD) remains controversial. Therefore, we performed a clinical study to elaborate on the implication of CTRPs (CTRP1, CTRP5, CTRP7, and CTRP15) in CAD. CTRP1 were significantly increased, whereas CTRP7 and CTRP15 levels were decreased in CAD patients compared to the non-CAD group. Significant differences in CTRP1 levels were discovered between the single- and triple-vascular-vessel lesion groups. ROC analysis revealed that CTRP7 and CTRP15 may …

Sevoflurane Pre-Conditioning Ameliorates Diabetic Myocardial Ischemia/Reperfusion Injury Via Differential Regulation Of P38 And Erk., Dina Xie, Jianli Zhao, Rui Guo, Liyuan Jiao, Yanqing Zhang, Wayne Bond Lau, Bernard Lopez, Theodore Christopher, Erhe Gao, Jimin Cao, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

Diabetes mellitus (DM) significantly increases myocardial ischemia/reperfusion (MI/R) injury. During DM, cardioprotection induced by conventional pre-conditioning (PreCon) is decreased due to impaired AMP-activated protein kinase (AMPK) signaling. The current study investigated whether PreCon with inhaled anesthetic sevoflurane (SF-PreCon) remains cardioprotective during DM, and identified the involved mechanisms. Normal diet (ND) and high-fat diet (HFD)-induced DM mice were randomized into control and SF-PreCon (3 cycles of 15-minute period exposures to 2% sevoflurane) groups before MI/R. SF-PreCon markedly reduced MI/R injury in DM mice, as evidenced by improved cardiac function (increased LVEF and ±Dp/dt), decreased infarct size, and decreased apoptosis. To determine …

Evaluating Cardiac Anatomy As A Predictor For Success After Pulmonary Vein Isolation For The Treatment Of Atrial Fibrillation, Paul Richter, Evan Rochlis, Ethan Halpern

Phase 1

Introduction: Atrial Fibrillation is a condition characterized by the production of ectopic beats by the heart. One common treatment for Atrial Fibrillation is catheter guided pulmonary vein isolation (PVI), however this treatment is only effective in around 60-70% of the population. Our research hopes to elucidate a link between cardiac anatomy and successful treatment of A-fib by pulmonary vein isolation.

Methods: The medical records for 78 consecutive patients who underwent PVI for atrial fibrillation at Jefferson from July 2013 to March 2016 were gathered. Included in these charts were ECG-gated cardiac CT angiogram and two-year follow up history. Different variables …

State-Level Cpr Education Legislation Associated With Higher Survival After Out-Of-Hospital Cardiac Arrest In Older Adults, Megan Barnes, David G. Buckler, Tyler D. Alexander, Marissa Lang, Alexis Zebrowski, Douglas J. Wiebe, Benjamin S. Abella, Brendan G. Carr

Phase 1

Introduction: State-level legislation requiring CPR education prior to high school graduation is associated with an increased likelihood of community-level CPR training. CPR Legislation has also been shown to be associated with increased bystander CPR. We hypothesized that states with CPR Legislation would be associated with higher survival following out-of-hospital cardiac arrest (OHCA).

Methods: Utilizing 2014 Medicare Claims data for emergency department visits and inpatient stays, we identified OHCA via ICD-9-CM code. CPR Legislation data was collected through online statute review. Exposure to CPR Legislation was assessed using the patient state of residence. All disposition categories were considered survival to discharge …

Evaluating The Impact Of Kardiamobile On Healthcare Expenditures, Christopher Gerace, Mph, Daniel Frisch, Md

Phase 1

Background: KardiaMobile is a mobile ECG device, with smartphone connectivity, that is able to detect atrial fibrillation (a-fib). The device captures a 30 second reading and an algorithm differentiates a-fib from sinus rhythm. The mobile application can alert the user to an a-fib reading and also send the ECG output to their personal physician. By monitoring a-fib without accessing traditional care, KardiaMobile has the potential to reduce healthcare costs for patients with a-fib. This study looked to evaluate the effect of KardiaMobile on healthcare utilization for patients with suspected or diagnosed a-fib and who see a clinical cardiac electrophysiologist.

Methods: …

Evaluation Of Ventricular Repolarization In Patients Undergoing Cardiac Resynchronization Therapy (Crt) Using Two Modalities: Conventional Biventricular Pacing Vs. His-Bundle Pacing, Anshul Gupta, Behzad B. Pavri, Md, Fhrs

Phase 1

Introduction:

Permanent His-bundle pacing (HBP) is being used as an alternative to biventricular pacing (BiVP) for CRT. HBP preserves the physiologic pattern of ventricular activation and markedly reduces ventricular dyssynchrony. While ventricular depolarization with HBP vs. BiVP has been studied, the effects of the 2 modalities on repolarization have not been compared. The purpose of this study was to compare ventricular repolarization in patients with HBP and BiVP. We hypothesize that HBP provides more physiologic repolarization as compared to BiVP.

Methods: ECG repolarization parameters were analyzed in patients who underwent HBP and BiVP using the first available ECG post implant. …

Pilot Evaluation Of The Usability And Utility Of A Wearable Technology To Monitor And Evaluate Health Condition, Drew Nielsen, David Shipon, Md, Facc, Facp

Phase 1

Introduction: Cardiac rehabilitation programs have particularly poor attrition and rehospitalization from cardiac-related events is a large burden on the medical system, as 8.9% of patients who have acute MI are rehospitalized within one year. External barriers may exist that prevent patients from adequately completing in-house cardiac rehabilitation, which makes them strong candidates for a home-based rehab program (HBCR). Previous randomized trials have generated evidence that HBCR can achieve similar cardiac improvements in 3- 12-month clinical outcomes. With the large-scale adoption of wearable technologies, with an estimated 8.2 million devices owned by individuals over 55, we have an opportunity to incorporate …

Continuous-Flow Left Ventricular Assist Device Outflow Graft Stenting: Indications And Outcomes, Chelsey T. Wood, Mfa, Elizabeth J. Maynes, Md, Thomas J. O'Malley, Md, Rohinton J. Morris, Md, Louis E. Samuels, Md, H. Todd Massey, Md, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Stenosis in the continuous-flow left ventricular assist device (CF-LVAD) outflow graft can be caused by various mechanical and anatomical factors. Increasingly, percutaneous management has been utilized to re-establish adequate CF-LVAD flow. We sought to evaluate indications for such interventions and their outcomes.

Methods: An electronic search was performed to identify all studies in the English literature reporting CF-LVAD outflow graft stenting for various etiologies. Twenty-one studies consisting of 26 patients were included in the analysis.

Results: Median patient age was 59 years [45.8-67.0] and 65.4% (17/26) were male. 58.3% (14/24) of patients had HeartWare HVAD, 37.5% (9/24) had HeartMate …

Cardiac Risk Factors Predicting 30/90 Day Readmission Rates In Lumbar Decompression Surgeries, Blake Nourie, Kevin Xiao, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

The Impact Of Native Language Status On The Frequency Of Heart Failure Readmissions, Cooper Blazek, Dave Katzianer, Md

Phase 1

Introduction. Heart failure readmissions are costly and lead to poor health outcomes. The efficacy of discharge instructions or other outpatient interventions may be affected by patient’s primary language status. The aim of this study is to look at the impact of primary language status on the frequency of heart failure admissions.

Methods. This study was a retrospective chart review of EMRs, on Epic software, at Jefferson academic medical center and community affiliate in Philadelphia, PA between March 2017 and October 2018. Patients were included if they had a principal diagnosis of HF or a diagnosis associated with “acute” heart failure …

Effect Of Contrast-Enhanced Echocardiograms On The Prognosis Of Infective Endocarditis, D. Arias, E. Halpern, F. Forsberg, J. R. Eisenbrey

Phase 1

Objective - Infective endocarditis (IE) is an infectious disease of the cardiac valves where bacteria colonize the valves; typically, via the formation of vegetations. Recent research has shown that the microbubbles in a contrast-enhanced ultrasound (CEUS) examination can move and dislodge bacterial vegetations in vitro. This study investigated whether CEUS resulted in faster resolution of IE in vivo by dislodging the vegetations.

Methods - This IRB approved retrospective study reviewed 36 patients who were diagnosed with IE via echocardiography. Data was sourced from patients within the Jefferson University Hospital’s Cardiology EMR system by searching for contrast and vegetation from …

Role Of Echocardiography In Diagnostic Evaluation Of Patients Admitted To Observation Unit., Muhammad Arslan Cheema, Hafez Mohammad Ammar Abdullah, Waqas Ullah, Yasar Sattar, Shujaul Haq, Khadija Cheema, Asrar Ahmad, Zain Ali, Asoka Balaratna

Abington Jefferson Health Papers

BACKGROUND: Syncope is a transient loss of consciousness due to transient decrease in cerebral perfusion. Syncope accounts for a 3-6% of all emergency department visits. Etiology of syncope can be neural, cardiogenic, or vascular. Previous studies have evaluated the types and management of syncope. Echocardiography is a commonly used test in the evaluation of causes of syncope. Whether the benefit compared to financial burden of this diagnostic study is in all subsets of syncope cases remains unclear.

AIM: To evaluate the impact of echocardiography in the diagnostic evaluation of syncope and to evaluate the subset of patients that would benefit …

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …

Heat Shock Factor 1-Mediated Transcription Activation Of Omi/Htra2 Induces Myocardial Mitochondrial Apoptosis In The Aging Heart., Dan Liu, Linguo Wu, Ye Wu, Xin Wei, Wen Wang, Suli Zhang, Ming Yi, Jing Li, Huirong Liu, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

BACKGROUND: Increased cardiac apoptosis is a hallmark of the elderly, which in turn increases the risk for developing cardiac disease. The overexpression of Omi/HtrA2 mRNA and protein contributes to apoptosis in the aged heart. Heat shock factor 1 (HSF1) is a transcription factor that binds to the promoter of Omi/HtrA2 in the aging myocardium. However, whether HSF1 participates in cardiomyocyte apoptosis via transcriptional regulation of Omi/HtrA2 remains unclear. The present study was designed to investigate whether HSF1 plays a role in Omi/HtrA2 transcriptional regulation and myocardial apoptosis.

METHODS AND RESULTS: Assessment of the hearts of mice of different ages was …

Patients Living With Hiv Infection Are Less Likely To Receive The Correct Statin Intensity For Cardiovascular Disease Risk Reduction, Jason J. Schafer, Pharmd, Mph, Roshni Emmons, Pharmd, Bcps, Nick V. Hastain, Pharmd, Todd Miano, Pharmd, Phd

College of Pharmacy Posters

• Patients living with HIV (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD)
• Eligible PLWH should receive statins for ASCVD risk reduction according to current guidelines
• Studies suggest that statins are underprescribed in PLWH, but comparisons to uninfected patients and assessments of statin intensity have not occurred

Objective

To determine the influence of HIV infection on appropriate statin prescribing for ASCVD risk reduction

Gsk3Β-Dependent Phosphorylation Of Cypd And Regulation Of Mptp Opening During Myocardial Infarction, Stephen Hurst, Ludovic Gomez, Shey-Shing Sheu

Center for Translational Medicine Posters

Background

Mitochondrial calcium overload and oxidative stress during ischemia reperfusion (I/R) injury remains a major obstacle during percutaneous coronary intervention after acute myocardial infarction. It often leads to an increased susceptibility for mitochondria permeability transition pore (mPTP) opening leading to cell death. Mitochondrial calcium overload and ROS have been identified as key triggers to open the mPTP for over 30 years, yet the exact mechanism has remained elusive. Additionally, glycogen synthase kinase 3β; (GSK-3β;) is proposed as one of the key molecules that regulate mitochondrial dysfunction and injury during I/R. Indeed inhibition of GSK-3β has been shown to be required …

Perioperative Use Of Renin-Angiotensin System Inhibitors And Outcomes In Patients Undergoing Cardiac Surgery., Qian Ding, Zugui Zhang, Hong Liu, Huang Nie, Mark Berguson, Jordan E. Goldhammer, Nilas Young, Douglas Boyd, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Faculty Papers

It remains disputable about perioperative use of renin-angiotensin system inhibitors (RASi) and their outcome effects. This multicenter retrospective cohort study examines association between use of perioperative RASi and outcomes in patients undergoing coronary artery bypass graft and/or valve surgery. After the exclusion, the patients are divided into 2 groups with or without preoperative RASi (PreRASi, n = 8581), or 2 groups with or without postoperative RASi (PostRASi, n = 8130). With using of propensity scores matching to reduce treatment selection bias, the study shows that PreRASi is associated with a significant reduction in postoperative 30-day mortality compared with without one …

Mechanisms Of Simvastatin Myotoxicity: The Role Of Autophagy Flux Inhibition., Arya Emami, Shahla Shojaei, Simone C. Da Silva Rosa, Mahmoud Aghaei, Ehsan Samiei, Amir Reza Vosoughi, Forouh Kalantari, Philip Kawalec, James Thliveris, Pawan Sharma, Amir A. Zeki, Mohsen Akbari, Joseph W. Gordon, Saeid Ghavami

Center for Translational Medicine Faculty Papers

Statins are some of the most widely used drugs worldwide, but one of their major side effects is myotoxicity. Using mouse myoblast (C2C12) and human alveolar rhabdomyosarcoma cell lines (RH30) in both 2-dimensional (2D) and 3-dimensional (3D) cell culture, we investigated the mechanisms of simvastatin's myotoxicity. We found that simvastatin significantly reduced cell viability in C2C12 cells compared to RH30 cells. However, simvastatin induced greater apoptosis in RH30 compared to C2C12 cells. Simvastatin-induced cell death is dependent on geranylgeranyl pyrophosphate (GGPP) in C2C12 cells, while in RH30 cells it is dependent on both farnesyl pyrophosphate (FPP) and GGPP. Simvastatin inhibited …

Functionalization Of Cd36 Cardiovascular Disease And Expression Associated Variants By Interdisciplinary High Throughput Analysis., Namrata Madan, Andrew R. Ghazi, Xianguo Kong, Edward S. Chen, Chad A. Shaw, Leonard C. Edelstein

Department of Medicine Faculty Papers

CD36 is a platelet membrane glycoprotein whose engagement with oxidized low-density lipoprotein (oxLDL) results in platelet activation. The CD36 gene has been associated with platelet count, platelet volume, as well as lipid levels and CVD risk by genome-wide association studies. Platelet CD36 expression levels have been shown to be associated with both the platelet oxLDL response and an elevated risk of thrombo-embolism. Several genomic variants have been identified as associated with platelet CD36 levels, however none have been conclusively demonstrated to be causative. We screened 81 expression quantitative trait loci (eQTL) single nucleotide polymorphisms (SNPs) associated with platelet CD36 expression …

Symmetrical Peripheral Gangrene Associated With Low Output Cardiac Failure., Sijan Basnet, Priya Rajagopalan, Rashmi Dhital, Ataul Qureshi

Department of Medicine Faculty Papers

Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.

Heart Failure With Preserved Ejection Fraction: A Review Of The Acc/Aha Guidelines And Evidence-Based Management Strategy, Vikas Sunder, Md

The Medicine Forum

Introduction

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which a patient has signs and symptoms of heart failure including dyspnea, fatigue, pulmonary rales, peripheral edema and an ejection fraction greater than 50%.1-4 Approximately half of patients with heart failure have a preserved ejection fraction.2-5 HFpEF is considered a distinct clinical entity from other causes of heart failure with a preserved ejection fraction such as valvular heart disease, pericardial disease, and infiltrative cardiomyopathy. HFpEF carries a poor prognosis, with an annual mortality of 29% in patients discharged after an acute decompensated heart failure admission.5 5-year survival …

Can Our Hearts Take The New Guidelines?, Eitan Frankel, Md

The Medicine Forum

No abstract provided.

C1q/Tnf-Related Protein 3 (Ctrp3) And 9 (Ctrp9) Concentrations Are Decreased In Patients With Heart Failure And Are Associated With Increased Morbidity And Mortality., Chao Gao, Shasha Zhao, Kun Lian, Baibing Mi, Rui Si, Zhijun Tan, Feng Fu, Shuai Wang, Rutao Wang, Xin-Liang Ma, Ling Tao

Center for Translational Medicine Faculty Papers

BACKGROUND: Biochemical marker has revolutionized the approach to the diagnosis of heart failure. However, it remains difficult to assess stability of the patient. As such, novel means of stratifying disease severity are needed. C1q/TNF-Related Protein 3 (CTRP3) and C1q/TNF-Related Protein 9 (CTRP9) are novel adipokines that contribute to energy homeostasis with additional anti-inflammatory and anti-ischemic properties. The aim of our study is to evaluate concentrations of CTRP3 and CTRP9 in patients with HFrEF (heart failure with reduced ejection fraction) and whether associated with mortality.

METHODS: Clinical data and plasma were obtained from 176 healthy controls and 168 patients with HFrEF. …

Effectiveness Of An Educational And Interdisciplinary Intervention In Reducing Continuous Cardiac Monitoring In An Academic Medical Center, Alexander Smith, Md, Rebecca Loh, Md, Philip Margiotta, Md, Bradford Hilson, Md, Alan Kubey, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Smart Aim Statement

• Our study aimed to assess the effect of a combined resident-education-and rounding-checklist-protocol intervention on the percentage of patients discharged with active CCM orders on teaching general medicine services.
• We hypothesized that our intervention would reduce the number of patients discharged on CCM (an estimate of overall inappropriate CCM use) by 50% over a 6-8 week period

View Point On Social Media Use In Interventional Cardiology, Mirvat Alasnag, Mamas Mamas, David Fischman, Salvatore Brugaletta, Jordan Safirstein, Pascal Meier, Vijay Kunadian, Lukasz Koltowski, Sheila Sahni, Chadi Alraies, Michael Gibson

Division of Cardiology Faculty Papers

No abstract provided.

Antibody-Based Ticagrelor Reversal Agent In Healthy Volunteers., Deepak L. Bhatt, Charles V. Pollack, Jeffrey I. Weitz, Lisa K. Jennings, Sherry Xu, Susan E. Arnold, Bret R. Umstead, Michael C. Mays, John S. Lee

Department of Emergency Medicine Faculty Papers

BACKGROUND: Ticagrelor is an oral P2Y₁₂ inhibitor that is used with aspirin to reduce the risk of ischemic events among patients with acute coronary syndromes or previous myocardial infarction. Spontaneous major bleeding and bleeding associated with urgent invasive procedures are concerns with ticagrelor, as with other antiplatelet drugs. The antiplatelet effects of ticagrelor cannot be reversed with platelet transfusion. A rapid-acting reversal agent would be useful.

METHODS: In this randomized, double-blind, placebo-controlled, phase 1 trial, we evaluated intravenous PB2452, a monoclonal antibody fragment that binds ticagrelor with high affinity, as a ticagrelor reversal agent. We assessed platelet function in …