Cardiology Commons^™

Hospitalization Trends For Thromboembolic Events In Atrial Fibrillation: A 12-Year National Analysis, Moises Vasquez, Crystal Yan, Natacha Vargas, Samuel Vasquez, Litsa Lambrakos, Alex Velasquez, Jeffrey Goldberger, Raul Mitrani

Division of Cardiology Faculty Papers

BACKGROUND: Direct oral anticoagulants and percutaneous left atrial appendage occlusion (LAAO) devices were approved for use in 2010 and 2015, respectively. It is unknown to what extent, if any, these new stroke preventive therapies have impacted hospitalizations for thromboembolic (TE) events.

OBJECTIVES: To evaluate temporal trends in AF-related hospitalizations for acute ischemic stroke (AIS), transient ischemic attack (TIA), and systemic embolism (SEE) in the U.S. from 2010 to 2021.

METHODS: Using the National Inpatient Sample, we identified hospitalizations for TE events with comorbid AF. Data were grouped into two periods (2010-2015 and 2016-2021). Linear regression assessed trends in TE frequency. …

From Aortic Stenosis To Cardiomyopathy: The Hidden Impact Of Undiagnosed Acommissural Unicuspid Aortic Valve, Muhammad Sabri, Hamza Muhammadzai, Angad Bedi, Eddy Mizrahi, Matthew Collins

Abington Jefferson Health Papers

Unicuspid aortic valve (UAV) is a rare congenital anomaly, diagnosed in individuals aged 30 to 50. It is associated with aortic stenosis or aortic regurgitation, potentially leading to heart failure. We report a case of a 28-year-old male with an acommissural UAV, aortopathy, critical aortic stenosis, and heart failure with reduced ejection fraction, presenting with shortness of breath. This case is notable for late presentation of an acommissural UAV, which typically manifests in childhood.

Incidence, Risk Factors And Clinical Outcomes Of Pericardial Effusion In Left Ventricular Assist Device Patients, Muhammad Zubair Khan, Yevgeniy Brailovsky, Mohammad Alfrad Nobel Bhuiyan, Gregary D. Marhefka, Abu S. M. Faisal, Adrija Sircar, Parker O'Neill, J. Eduardo Rame, Sona Franklin, Muhammad Waqas, Hadia Shah, Indranee Rajapreyar, René J. Alvarez

Division of Cardiology Faculty Papers

BACKGROUND: Development of pericardial effusion in patients with left ventricular assist devices (LVADs) can be detrimental to health outcomes. This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.

AIM: To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion. The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.

METHODS: Data were obtained from the National Inpatient Sample database between 2016 and 2018. Statistical …

Hydropneumopericardium Due To Esophageal-Pericardial Fistula: A Rare Complication Of Esophageal Stenting, Svenja Schneider, Margaret Doyle, Suzanna Talento, Waqas Ullah, Gregary D. Marhefka

Division of Cardiology Faculty Papers

We present a case of a 53-year-old woman with a history of ulcerative esophagitis and esophageal stricture status post esophageal stenting that was complicated by stent migration. She presented with fatigue, melena, and dark output from her percutaneous endoscopic gastrostomy tube. An echocardiogram showed hydropneumopericardium with cardiac tamponade physiology requiring emergent pericardiocentesis. The aspirated fluid was brown and cloudy; pathology of the fluid showed meat and vegetable matter consistent with food. She ultimately required esophagectomy with esophagostomy. This case highlights the importance of early recognition of esophageal-pericardial fistulas, as delay in the management carries a high risk for morbidity and …

Plug And Coil Procedure For Management Of Large Postinfarct Ventricular Septal Defect, Hussam Al Hennawi, Sergio Flores, Michael Little, Lacy Harville, Ahmad Almomani, Muhammad Hammadah

Abington Jefferson Health Papers

Acute surgical mortality for postinfarction ventricular septal rupture remains alarmingly high at approximately 50%. In comparison, medical mortality is nearly 100% and likely exceeds historical levels because of the declining frequency of these acute surgeries, with many surgeons now performing fewer than 1 or 2 annually. Percutaneous device closure has become a feasible option for managing postinfarction ventricular septal defects in carefully selected patients. However, this technique may be associated with challenges such as significant residual shunting, delayed endothelialization, hemolysis, and extended hospital stays. Here, we present a novel approach using coil packing to enhance closure and reduce shunting.

Racial And Ethnic Representation And Study Engagement In A Siteless Digital Clinical Trial Using A Smartwatch: Findings From The Apple Heart Study., Kaylin T. Nguyen, Jingzhi Yu, Haley Hedlin, Adam T. Phillips, Sumbul Desai, Lauren Cheung, Peter R Kowey, Sneha S. Jain, John S. Rumsfeld, Andrea M. Russo, Christopher B. Granger, Mellanie True Hills, Manisha Desai, Kenneth W. Mahaffey, Mintu P. Turakhia, Marco V. Perez

Department of Medicine Faculty Papers

OBJECTIVE: To evaluate differences in study engagement in diverse racial/ethnic groups that have been significantly underrepresented in atrial fibrillation and digital clinical trials.

PATIENTS AND METHODS: This was a secondary analysis of participants from the Apple Heart Study, a prospective, siteless, single-arm pragmatic clinical trial from November 29, 2017, to January 31, 2019. Black, Hispanic, Asian, and White participants were monitored using an irregular rhythm notification algorithm designed to detect atrial fibrillation on a smartwatch. Logistic regression was performed to evaluate the relationship between race/ethnicity and completion of the first study visit after an irregular rhythm notification, adjusting for demographic …

Antiarrhythmic Drug Use In Atrial Fibrillation Among Different European Countries – As Determined By A Physician Survey, Espen Fengsrud, Carina Blomström-Lundqvist, A. John Camm, Andreas Goette, Peter R. Kowey, Jose L. Merino, Jonathan P. Piccini, Sanjeev Saksena, James A. Reiffel, Giuseppe Boriani

Department of Medicine Faculty Papers

BACKGROUND: There is limited knowledge of physicians' antiarrhythmic drug (AAD) treatment practices for patients with atrial fibrillation and adherence to guidelines in European countries.

METHODS: An online survey (n = 321) of cardiologists, cardiac electrophysiologists and interventional electrophysiologists was conducted in Germany (DE; n = 83), Italy (IT; n = 95), Sweden (SE; n = 60) and the United Kingdom (UK; n = 83) including 96 questions on treatment practices.

RESULTS: ESC guidelines were the most important non-patient factor influencing treatment practice (55-72 %). However, while amiodarone was frequently (88-93 %) used in heart failure with reduced left ventricular ejection …

Cardiac Amyloid, The Great Imitator, Nolan R. Fox, Nicholas J. Fox, Emily Newman, Brian Osler, Eugene Storozynsky

Division of Cardiology Faculty Papers

BACKGROUND: Although endomyocardial biopsy (EMB) is the criterion standard for diagnosis of infiltrative cardiac disease, cardiac sarcoidosis (CS) or cardiac amyloid can be diagnosed noninvasively through both clinical suspicion and advanced imaging techniques of cardiac magnetic resonance imaging (CMR) or cardiac positron emission tomography (PET).

CASE SUMMARY: A 79-year-old man with mediastinal sarcoidosis presented with new chest pain and a right bundle branch block, raising concern for CS. CMR and cardiac PET also supported the diagnosis of CS, but EMB ultimately revealed transthyretin amyloid cardiomyopathy. The patient was started on tafamidis and showed improvement at 1-year follow-up.

DISCUSSION: This case …

Identifying Unnecessary And Excessive Use Of Intravenous Heparin For The Treatment Of Intermediate-Risk Pulmonary Embolism, Youssef Elfatatry, Ryan Gardner, Chukwuemezie Kamanu, Ruben Rhoades

Health Equity and Quality Improvement (HEQI) Summit

Problem Statement

- Intermediate-risk pulmonary embolism (PE) is a diagnosis with heterogenous presentations and mortality rates ranging from 2% to 15%.

- European Society of Cardiology (ESC) guidelines recommend low-molecular weight heparin (LMWH) as first line therapy in most patients. Despite this, the use of IV heparin in intermediate-risk PE remains widespread, due to uncertainty regarding patients receiving further procedures and mitigation of bleeding risk.

Project AIM:

- We aim to (1) identify prescribing patterns and outcomes of anticoagulant therapy on admission, and (2) propose and implement a "PE Care Pathway" in EPIC to address uncertainty in risk-stratifying and treating …

By The Book: A Look At Whether Guidelines Impact Clinical Decision Making In Sglt2i Prescriptions, Marc Mounzer, Vacha Shah, Antony Fuleihan, Brian Osler

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Specialty-specific guidelines reduce medical errors and support clinical decision- making
• Effective implementation requires timeliness and accuracy, often limited by systemic barriers
• This study investigates factors affecting sodium glucose cotransporter 2 inhibitor (SGLT2i) prescribing in heart failure to enhance guideline adherence and care quality

Prevalence Of Cardiovascular-Kidney-Metabolic Stages In Us Adolescents And Relationship To Social Determinants Of Health, Carissa M. Baker-Smith, Abigail M. Gauen, Lucia C. Petito, Sadiya S. Khan, Norrina B. Allen

Department of Pediatrics Faculty Papers

BACKGROUND: Risk factors for atherosclerotic cardiovascular disease begin in youth. Knowledge of the prevalence of cardio-kidney-metabolic (CKM) syndrome in adolescents and its risk factors is critical to understanding the cause of atherosclerotic cardiovascular disease risk burden.

METHODS: We conducted a cross-sectional analysis of the 2017 to 2020 US National Health and Nutrition Examination Survey data and determined the prevalence of each CKM stage in adolescents aged 12 to 18 years. We then assessed the relationship between the family income-to-poverty ratio, health insurance, routine health care access, food security, health behaviors, and CKM stage. We quantified associations between social factors, behaviors, …

Serendipitous Supernormality, Behzad B. Pavri, Eitan Frankel

Division of Cardiology Faculty Papers

We describe a patient who underwent AV node modification to create complete heart block in the setting of incessant, ablation-and-drug-refractory, symptomatic atypical atrial flutter. His dual chamber defibrillator (previously implanted for resuscitated cardiac arrest) was programmed to the VVIR mode at a faster pacing rate of 85 bpm. Serendipitously, this rate was an almost exact factorial of his flutter rate of 250-260 bpm. This resulted in every 6th flutter wave falling in the supernormal period, resulting in fixed-coupled supraventricular bigeminy and trigeminy in the setting of complete heart block. Reprogramming the pacing rate to 75 bpm abolished bigeminy and trigeminy.

Novel Application Of Orthopedic Suture Tape For Sternal Closure After Upper Hemisternotomy, Vishal N. Shah, Joshua R. Chen, Konstadinos A. Plestis

Department of Surgery Faculty Papers

The FiberTape (FT) System (Arthrex, Naples, FL, USA), initially developed for orthopedic surgery, is a new, nonmetallic, suture-based alternative to standard stainless-steel wires for sternal reapproximation. Publications on FT use after cardiothoracic surgery are limited. The FT System has not been used in upper hemisternotomy (UHS) closure. Consequently, we report the use of the FT System for sternal closure in a 70-year-old man after UHS aortic valve replacement and discuss several advantages of its application.

Plasma Proteomic Biomarkers Of Physical Frailty In Heart Failure: A Propensity Score Matched Discovery-Based Pilot Study, Quin Denfeld, Noelle Pavlovic, Christopher Lee, Jon Jacobs, Mary Roberts Davis, Samantha Powell, Marina Gritsenko, Susan Joseph, Beth Habecker

Division of Cardiology Faculty Papers

BACKGROUND: Physical frailty is highly prevalent in heart failure (HF), but we lack an understanding of the underlying pathophysiology. Proteomic evaluation of plasma samples may elucidate potential mechanisms and biomarkers of physical frailty in HF.

OBJECTIVES: We aimed to identify plasma proteomic biomarkers that are differentially expressed between physically frail and non-physically frail adults with HF.

METHODS: This was a secondary analysis of a subset of data and plasma samples from a study of frailty among patients with New York Heart Association (NYHA) Functional Classification I-IV HF. Physical frailty was measured using the Frailty Phenotype Criteria. Propensity score matching was …

Addressing Frailty In Heart Failure: Essential Tools & Strategies For Occupational Therapists, Malachy Clancy, Phd, Otr/L, Bcpr

Department of Occupational Therapy Posters and Presentations

Learning Objectives

• Understand and describe the concept of frailty and its impact on occupational performance for patients with heart failure (HF).
• Identify comprehensive assessments that encompass physical, cognitive, and psychosocial domains to provide a holistic assessment of frailty.

Pediatric And Congenital Cardiac Services: An Innovative And Empowering Approach To Global Training And Equitable Care, Wyman W. Lai, Dominique Vervoort, David Bradley, Antonio G. Cabrera, Casey Culbertson, Alejandro Floh, Saurabh K. Gupta, Babar S. Hasan, Adrian Holloway, Jeffrey P. Jacobs, Kathy J. Jenkins, R. K. Kumar, L.A. Larrazabal, Colin J. Mcmahon, Daniel J. Penny, Alistair Phillips, Emilio Quezada, Craig A. Sable, Shubhika Srivastava, Sandra L. Staveski, Patcharapong Suntharos, David F. Teitel, Betsy Tirado, Brian C. Tran, Bistra Zheleva, Liesl Zuhkle, Anthony C. Chang

Division of Cardiology Faculty Papers

Congenital heart disease is a leading cause of preventable death in children, with a disproportionate impact on low- and middle-income countries. Despite progress in treating congenital heart disease globally, significant challenges remain in accessing specialized cardiovascular care, particularly cardiac surgery, in low- and middle-income countries. This review examines current models of assistance and proposes a novel global training program to address these inequities. Key challenges identified include building program infrastructure, training health care providers, ensuring financial sustainability, and promoting local engagement. The proposed program, structured under a new international organization, will leverage emerging technologies to deliver accessible and rigorously assessed …

The Role Of Non-Statin Lipid Lowering Therapies To Reduce Ascvd Events In Primary Prevention, Chukwuemezie Mamanu, Dean Karalis

Division of Cardiology Faculty Papers

PURPOSE OF REVIEW: Atherosclerotic cardiovascular disease (ASCVD) remains a leading global health challenge, with low-density lipoprotein (LDL) cholesterol a pivotal risk factor. While statins are cornerstone therapy for lowering LDL cholesterol, many high-risk primary prevention patients are unable to tolerate statin therapy and do not achieve their guideline directed LDL cholesterol goal. For these patients, non-statin therapies offer complementary and alternative approaches to LDL cholesterol reduction.

RECENT FINDINGS: Recent advancements in non-statin therapies have expanded the options available to clinicians to lower LDL cholesterol in high-risk primary prevention patients. Yet these medications are often under-utilized in clinical practice. Observational studies, …

Left Ventricular And Aortic Pressures Measured With Fluid-Filled And Solid-State Pressure Catheters: Similarities And Differences, Priscilla Machado, Ira Cohen, Brian Osler, Maureen E. Mcdonald, Cara Esposito, Marguerite Davis, David Fischman, Michael P. Savage, Praveen Mehrotra, Flemming Forsberg, Jaydev K. Dave

Division of Cardiology Faculty Papers

Objective: To compare left ventricular (LV) and aortic (AO) pressures obtained using fluid-filled and high-fidelity solid-state pressure catheters in subjects undergoing left heart catheterization.

Materials and Methods: Twenty subjects scheduled for a left heart catheterization were enrolled and 18 subjects completed this IRB-approved study. LV and AO pressures were obtained using fluid-filled pressure catheter (standard-of-care) and high-fidelity solid-state pressure catheter synchronously. Pressure tracings were analyzed to measure LV systolic (LVSP), LV minimum-diastolic (LVMDP), LV end-diastolic (LVEDP), AO systolic (AOSP), and AO diastolic (AODP) pressures. Isovolumic contraction and relaxation rates (peak ± dp/dt) were derived from the pressure waveforms. Repeated measures …

The Future Direction Of Post-Transcatheter Aortic Valve Replacement Reinterventions: Insights From The Transcatheter Valve Therapy Registry, Edward Percy, Joseph E. Bavaria

Division of Cardiology Faculty Papers

No abstract provided.

Characterization Of Novel Arrhythmogenic Patterns Arising Secondary To Heterogeneous Expression And Activation Of Nav1.8, Zhong-He Zhang, Hector Barajas-Martinez, Hong-Yi Duan, Guo-Hua Fan, Hong Jiang, Charles Antzelevitch, Hao Xia, Dan Hu

Department of Medicine Faculty Papers

Background: Previous studies suggested that SCN10A/Nav1.8 may influence cardiac electrophysiology and the susceptibility to cardiac arrhythmias. Notably, the expression of SCN10A is not uniform, showing variable expression in each cardiac chamber. The present study aims to explore the functional significance of Nav1.8 expression among different cell types present in the ventricular myocardium.

Methods: The effect of the specific Nav1.8 blocker, A-803467, on action potential was recorded from epicardial, mid-myocardial (M cells) and Purkinje tissue slices isolated from the canine left ventricle using standard microelectrode techniques and on late sodium current from Purkinje cells using patch-clamp techniques.

Results: A-803467 treatment …

First Documented Case Of A Third-Generation Lvad Rotor Dislodgement, Tyler Lee, Chaitra Janga, Enad Haddad, Kevin Hagan, Donald C. Haas

Abington Jefferson Health Papers

The third-generation left ventricular assist device (3G-LVAD) has significantly reduced adverse events and hospitalizations compared with previous generations. This case presents a rare 3G-LVAD rotor dislodgement malfunction, not previously documented, in a 77-year-old man. Further research behind the malfunction is warranted for early prevention and appropriate management.

Echocardiography And Heart Failure: An Echocardiographic Decision Aid For The Diagnosis And Management Of Cardiomyopathies., Ashley Pender, Jessica Lewis-Owona, Abdulmojeed Ekiyoyo, Marcus Stoddard

Division of Cardiology Faculty Papers

PURPOSE OF REVIEW: The purpose of this review is to highlight the utility of echocardiography in the diagnosis and management of cardiomyopathies.

RECENT FINDINGS: Echocardiographic parameters function synergistically to guide decision-making ranging from early detection of disease and screening to risk stratification of complex disease. The collective wealth of information available from 2D/3D assessment, Doppler, diastology and strain makes echocardiography an invaluable decision aid.

Novel Device Therapies In Heart Failure: Focus On Patient Selection, Amrita Balgobind, Daniel Asemota, Emily Rodriguez, Phuuwadith Wattanachayakul, Marat Fudim, Miguel Alvarez Villela

Einstein Health Papers

The increasing prevalence of heart failure (HF) has led to advancements in therapeutic strategies, including the development of new pharmacological treatments and the expansion of guideline recommendations across the spectrum of left ventricular ejection fractions. Despite these advancements, the full benefits of guideline-directed medical therapy (GDMT) are often limited by various barriers that result in incomplete implementation or suboptimal responses. For patients who cannot tolerate or only partially respond to GDMT, therapeutic options remain limited. This gap is particularly significant for those with contraindications to heart replacement therapies (HRT), such as left ventricular assist device (LVAD) or heart transplant. In …

Clinical Variability In Presentation And Management Of Quadricuspid Aortic Valve: A Case Series, Douglas Corsi, Brooke Kelly, Nikta Nair, Meiqi Luo, Brian Osler, Sung-Hae Cho, Praveen Mehrotra, David H Wiener, Drew Johnson

Division of Cardiology Faculty Papers

• Rare presentation of three QAV cases with varied clinical manifestations is reported. • Multimodal imaging is crucial for accurate QAV diagnosis and classification. • QAV is often associated with aortic regurgitation requiring intervention. • Surgical repair is preferred over replacement in suitable patients with QAV. • Long-term follow-up is essential for patients with QAV, even if asymptomatic.

Automated Detection Of Reduced Ejection Fraction Using An Ecg-Enabled Digital Stethoscope: A Large Cohort Validation, Ling Guo, Gregg S. Pressman, Spencer N. Kieu, Scott B. Marrus, George Mathew, John Prince, Emileigh Lastowski, Rosalie V. Mcdonough, Caroline Currie, John N. Maidens, Hussein Al-Sudani, Evan Friend, Deepak Padmanabhan, Preetham Kumar, Edward Kersh, Subramaniam Venkatraman, Salima Qamruddin

Einstein Health Papers

BACKGROUND: Asymptomatic left ventricular systolic dysfunction (ALVSD) affects 7 million globally, leading to delayed diagnosis and treatment, high mortality, and substantial downstream health care costs. Current detection methods for ALVSD are inadequate, necessitating the development of improved diagnostic tools. Recently, electrocardiogram-based algorithms have shown promise in detecting ALVSD.

OBJECTIVES: The authors developed and validated a convolutional neural network (CNN) model using single-lead electrocardiogram and phonocardiogram inputs captured by a digital stethoscope to assess its utility in detecting individuals with actionably low ejection fractions (EF) in a large cohort of patients.

METHODS: 2,960 adults undergoing echocardiography from 4 U.S. health care …

Safety And Efficacy Of Different Stent Strategies In Percutaneous Coronary Intervention: A Network Meta-Analysis, Waqas Ullah, Harigopal Sandhyavenu, Syeda Ramsha Zaidi, Mileydis Alonso, Muhammad Atif Khan, Irfan Ullah, Farah Yasmin, Aravind Reddy Polam, Salman Zahid, Arnav Kumar, Ewout Steyerberg, Mohammed Murtaza, Chadi Alraiesm, Jeffrey Rade

Jefferson Health - Northeast Papers (formerly Aria Health Papers)

BACKGROUND: The utility of polymer-permanent, polymer-absorbable, and polymer-free drug-eluting stents (DES) in the context of different eluting drugs in patients undergoing percutaneous coronary intervention (PCI) remains controversial.

OBJECTIVES: The purpose of this study was to compare the efficacy of different DES strategies in post-PCI patients.

METHODS: Digital databases were searched to select all randomized control trials. Different combinations of DES were directly compared with permanent-polymer sirolimus-eluting stents. The primary outcome was major adverse cardiovascular events; a composite of cardiovascular mortality, myocardial infarction (MI), and target vessel revascularization. A network meta-analysis was performed to determine the net relative risk (RR) and …

Cardiac Screening Findings And Referral Patterns In Male African-American Basketball Players: Analysis Of The Heartbytes Registry, Douglas Corsi, Avinash Saraiya, Maggie Doyle, Vacha Shah, Blaise O'Malley, Grace Qiu, Renee Lanstaff, Imran Masood, Brian Osler, Alexander G. Hajduczok, Drew Johnson, David Shipon

Student Papers, Posters & Projects

Sudden cardiac death (SCD) is the leading medical cause of death in young athletes. Male African American basketball players (MABP) demonstrate particularly elevated risk for SCD. Despite increasing screening and preventative efforts, the incidence of SCD remains elevated in this population. This retrospective analysis of the HeartBytes National Youth Cardiac Registry (2015-2023) aimed to characterize cardiac screening findings, including symptoms, family history, physical exam, and electrocardiogram (ECG) abnormalities in MABP compared to other youth athletes undergoing cardiac screening. We secondarily examined referral patterns based on screening results between the two groups. Of 8,303 individuals screened, 200 MABP were identified. MABP …

Effect On Cardiovascular Outcome Of Sodium-Glucose Co-Transporter-2 (Sglt2) Inhibitors Among Cancer Patients Treated With Anthracycline: A Systematic Review And Meta-Analysis, Chalothorn Wannaphut, Phuuwadith Wattanachayakul, Sakditad Saowapa, Ben Ponvilawan, Manasawee Tanariyakul, Jakrin Kewcharoen, Pitchaporn Yingchoncharoen, Thanathip Suenghataiphorn, Noppawit Aiumtrakul, Jared Acoba

Department of Medicine Faculty Papers

Background/objectives: Sodium-glucose-co-transporter-2 (SGLT2) inhibitors have shown benefit in reducing cardiovascular disease outcomes in diabetes patients. Anthracycline therapy is associated with a risk of cardiomyopathy. However, the impact of SGLT2 inhibitors in the prevention of cardiomyopathy and heart failure in cancer patients undergoing anthracycline treatment remains unclear. Thus, we conducted a systematic review and meta-analysis to explore the effect of the prevention of cardiovascular outcomes in patients with cancer and diabetes who had received anthracycline therapy.

Methods: We systematically reviewed Medline and EMBASE databases from inception to January 2024 for studies focusing on cancer patients with a history of anthracycline therapy. …

Consistency Of Hfref Treatment Effect In Underrepresented Groups In Randomized Clinical Trials, Guillaume Baudry, Luca Monzo, Mark C. Petrie, Nicolas Girerd, Iliana L Piña, Alexandre Mebazaa, Javed Butler, Leila Abid, Faiez Zannad, Harriette G.C. Van Spall

Division of Cardiology Faculty Papers

Despite the established efficacy of heart failure (HF) guideline-directed medical therapies, implementation varies across demographic groups, including Black, Indigenous, and people of color, older adults, females, and those who are socioeconomically deprived. This review synthesizes the representativeness of trial participants and describes subgroup analyses from pivotal trials in HF with reduced ejection fraction (HFrEF). It reviews the largely consistent treatment effect of medical therapies across the demographic groups represented in trials. It makes arguments for broad implementation of therapies based on these data, while calling for more representative trials to improve research and health equity in HF.

Neurovascular Complications Of Acute Aortic Syndrome, Dean Zeldich, Matthew Bierowski, Leah Shabo, Sridhara Yaddanapudi, Gregary Marhefka

Jefferson Hospital Staff Papers and Presentations

Acute aortic syndromes (AAS) such as aortic dissection, intramural hematoma, and penetrating aortic ulcer pose significant neurovascular risks, affecting patient outcomes. This review examines the incidence, clinical presentation, and outcomes of neurovascular complications in AAS patients. Common complications include stroke, spinal cord ischemia, and transient ischemic attacks, with stroke being the most prevalent. Managing aortic dissection necessitates careful blood pressure control to prevent dissection progression while avoiding compromised cerebral and spinal perfusion. Carotid involvement, particularly dissection, increases stroke and transient ischemic attack risks. Emergency surgical interventions, though essential to prevent rupture or repair dissection, carry risks of perioperative neurovascular complications. …